Prostate Cancer | International Urology Centre

In 2015, I lost a close friend to an aggressive cancer. It was devastating as he was a very good friend and only two years older than me. It was and still is a painful reminder on how cancer can affect our lives. As a urologist, I face cancer regularly through my patients, and would like to help readers to understand some of the issues doctors and patients face when dealing with prostate and other urological cancers.

Prostate cancer is the third most common cancer in Singapore behind lung and colorectal cancers. The prostate - a small walnutsized organ that only males have - is both a gift and a curse. Its main function is to provide lubrication and fluid for the sperms to swim in during ejaculation but it can present cancer and non-cancer problems, and diagnosis can be a challenge.

PSA testing

This blood test can help a doctor decide whether to perform a prostate biopsy to detect suspected cancer. But because it can be elevated for non-cancer reasons as well, it becomes less of a failsafe option.

Today, MRI of the prostate is used more often, sometimes before biopsy to detect the spread of cancer outside the prostate gland, and more often after biopsy, to detect metastasis.

Like all blood cancer markers, PSA is not 100% accurate. But it is the most accurate blood cancer test we have and the real challenge is to interpret it. Some patients ditch the PSA testing but that could mean delay in diagnosis with an increased incidence in advance prostate cancer. The real question should not be whether to keep or drop PSA testing, but how best to use it.

The consensus is that PSA should not be used as a random screening tool but as a directed and targetted tool for those at higher risk/with symptoms.

Choosing The Best Therapy

Doctors face the challenge of analysing each patient and offering the best treatment option as opposed to close monitoring.

In general, most prostate cancers are slow-growing and small. The question is whether the patient is comfortable with close monitoring with regular blood taking for PSA, periodic MRI prostate scans and repeat prostate biopsies when indicated on follow-up.

Some patients are not, as they are young and do not see themselves on this monitoring regimen. The conversation between patient and doctor detemines the best way forward if the cancer is deemed non-aggressive.

For patients with more aggressive but early prostate cancer, the doctor has to decide which treatment option is best for the patient.

Recent advances in robotic surgery for prostate cancer mean that the risk of significant urinary incontinence has greatly reduced and the need for adult diapers for 12 weeks post-surgery is minimal.

The recovery of erectile function post-surgery still varies depending on factors such as the ability to preserve the nerves without compromising cancer control, age and male hormonal levels. Targetted radiation is another well established treatment option.

Emerging options in certain parts of the world include HIFU, Focal therapy with Proton and Cryoablation with long-term results pending.

The old saying that all prostate cancer is slow growing and most men will die from other causes before prostate cancer is true only if the prostate cancer is indeed slow growing.

Reducing The Risk

Evidence from clinical studies shows that the following may reduce risk of prostate cancer:

Soya products Contain phytoestrogens which delay growth of prostate cancer.

Green tea Polyphenols can inhibit prostate cancer cells.

Tomatoes Lycopene, a carotenoid that kills cancer cells.

Antioxidants Selenium and vitamin E can reduce the risk of prostate cancer.

Reduced animal fat intake Studies show that a diet with 26g of fat per day has an additional attributable risk of 13% compared to 13g of fat per day.

Conclusion

A cancer diagnosis is devastating to the patient and their loved ones, but the treatment of it need not be so.

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PSA testing

Choosing The Best Therapy

Reducing The Risk

Conclusion

Dr Michael Wong

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