Prostate cancer has been on the rise, particularly in most parts of the Western world. According to Dr Gerald Tan, urologist at Mount Elizabeth Novena Hospital, "Prostate cancer surpasses the prevalence of other male cancers in America, Europe and Australia, and ranks 3rd in Singapore."
Dr Tan adds, "It is widely believed that prostate cancer is a disease of affluence." This is because a Western diet plays a big role in triggering the disease due to excessive red meat, dairy products and gluten (a protein in cereal grains), which are food staples in the West. Dr Tan notes that in Japan and South Korea, where people consume less of these foods, the incidence of prostate cancer is much lower.
Nonetheless, Dr Tan stresses that eating habits are not the sole risk factor for prostate cancer. "The other big risk factor is a family history of prostate cancer." The National Cancer Institute (NCI) of the US has reported that 5 – 10% of prostate cancer cases stem from inherited genes.
How to screen for prostate cancer
In recent years, blood tests have been used to screen patients without symptoms. These tests measure the amount of prostate-specific antigens (PSA), which is a protein produced by the prostate gland, in the bloodstream.
"The PSA test is now universally used as a marker to predict the likelihood of prostate cancer," says Dr Tan. The higher the PSA level is, the greater the risk of prostate cancer. A PSA quantity exceeding 10 ng/mL of blood is associated with a 50% chance of prostate cancer. However, Dr Tan cautions that "the test cannot confirm whether you have prostate cancer."
If a high level of PSA is detected in your bloodstream, further examinations may be required, such as a transrectal ultrasound guided biopsy – where a needle is inserted into the rectum to extract a tissue sample from the prostate gland.
Treatment: from surveillance to surgery
If patients are found to have prostate cancer, Dr Tan emphasises that they should be aware that prostate cancer is a very curable disease.
For instance, early-stage patients usually do not require treatment but simply have to engage in active surveillance. "For these patients, the risk of the cancer spreading outside the prostate is very low," says Dr Tan. "They just need to do the PSA test once every few months and a biopsy every year to make sure the cancer is not becoming more malignant. The earlier we find the cancer (spreading), the more nerves we are able to preserve."
With active surveillance, many patients with low-risk prostate cancer can enjoy a normal life for many years before undergoing treatment for prostate cancer.
Once prostate cancer reaches a stage requiring treatment, surgery is often the most effective approach. "Surgery alone or in combination with radiation or hormone therapy is the bedrock of treatment for prostate cancer because it offers the best survival rates in the long term," says Dr Tan.
Robotic-assisted surgery, or robotic surgery, is often the treatment of choice since it outperforms both minimally invasive surgery and open surgery in terms of blood loss, transfusion rate and degree of pain. This is because "robotic instruments are superior at visualising the fine tissues surrounding the prostate and can twist or turn in all sorts of ways," notes Dr Tan.
As a result, surgeons are able to precisely target the affected area and minimise damage to the surrounding nerves that are responsible for urine control and erectile function. Patients can thus recover faster from urinary incontinence (involuntary leakage of urine) and erectile dysfunction, which are common side effects of conventional prostate surgery.