The prostate is a gland found exclusively in males. Located in front of the rectum and below the urinary bladder, the prostate is about the size of a walnut. The prostate reaches nearly full size during puberty but may continue to grow slightly more in older men and it produces some of the fluid that protects and nourishes sperm cells in semen. Glands called seminal vesicles that make most of this fluid are found behind the prostate. Prostate cancer usually occurs in the epithelial cells of the glandular tissue. This type of cancer is known as adenocarcinoma.
*People who think they may be at risk should discuss this with their doctor.
The growth rate of prostate cancer varies among men. In some men, prostate cancer develops slowly and does not cause any problem. Yet, it grows faster in some others and can result in severe pain or other problems, even death. Screening tests can help to detect prostate cancer early.
This is the first step in diagnosing prostate cancer. The doctor uses a gloved finger to examine the rectum.
PSA is a substance produced by both normal and malignant prostate cells. The presence of elevated levels of PSA in the blood is another test that helps to detect prostate cancer.
TRUS is the use of soundwaves to create an image of the prostate. It is used to guide a biopsy of the prostate.
This procedure removes some sample tissue for analysis. If the biopsy is positive for cancer, imaging such as bone scan, Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) scanning of the pelvis may be needed to help determine the extent of the cancer.
A procedure called radical prostectomy may be recommended if the tumour is localised at the prostate. It involves the complete removal of the prostate and often includes the pelvic lymph nodes. This procedure is commonly used to treat early stages of prostate cancer. Some possible side effects of radical prostectomy include incontinence (not being able to control urine) and impotence (not being able to have erections). These side effects can also happen with other forms of treatment for prostate cancer.
Radiation therapy uses high-energy beams to kill the cancer cells. External beam radiotherapy (EBRT) focuses radiation from outside the body on the cancer. EBRT techniques involved may include Three-dimensional Conformal Radiation Therapy (3D-CRT) where radiation beams are shaped and aimed at the tumour from several directions. Stereotactic Body Radiation Therapy (SBRT) uses highly focused beams of high-dose radiation given on one day or over several days. Brachytherapy is another form of radiotherapy that involves the surgical placement of permanent or temporary implants to deliver radiation to the prostate.
Hormonal therapy is commonly used to treat prostate cancer when it has spread or in combination with radiotherapy when the cancer is locally advanced or high risk. Hormonal therapy can slow the cancer growth as it interferes with the growth stimulatory effects of male hormones on prostate cancer. There are two forms of hormonal therapy:
Though uncommon, chemotherapy plays a role in improving symptoms of prostate cancer if hormone therapy is ineffective. It is generally well-tolerated and can alleviate bone pain for most patients. Chemotherapy is usually given in cycles with each cycle lasting for a few weeks. The body is given time to recover during a rest period that follows each cycle of treatment.
As some prostate cancers grow very slowly and may take many years to cause symptoms or spread, some men with diagnosed prostate cancer may not need immediate treatment. Active surveillance refers to a protocol that allows patients with localized prostate cancer to be observed safely for a period of time, and then for deferred treatment when necessary. Watchful waiting is also advocated as a reasonable approach for some men with prostate cancer (especially asymptomatic men with a limited life expectancy) who are observed and treated only when symptoms or spread occurs.
Energy ablative therapies such as cryotherapy have been offered as minimally invasive therapy options for highly selected men with localized prostate cancer. Cryotherapy involves placing cryoneedles into the prostate through the perineal skin, and uses controlled freezing and thawing to destroy prostate cancer cells. This form of treatment is sometimes used in men whose prostate cancer has returned following other treatments.
Prostate cancer is a complex heterogenous disease , ranging from low-risk indolent disease that may only require surveillance, to high-risk life-threathening disease which needs aggressive curative treatment.
Here at the NCIS, we provide comprehensive management that is tailored to the individual patient.
We have an experienced multi-disciplinary team of uro-oncologic surgeons; medical oncologists and radiation oncologists providing the full spectrum of treatment options available. This team of clinicians is supported by an excellent paramedical team of advanced specialty nurses, pelvic floor physiotherapists, sex counsellors and medical social workers to help us provide holistic care of the patient.
We provide the whole range of diagnostic and treatment options including the latest in MRI and PET scan imaging; robotic assisted MRI guided biopsies; robotic assisted minimally invasive surgery, and advanced radiotherapy techniques.
Being the foremost academic medical centre in Singapore, our centre takes part in many of the latest international groundbreaking clinical trials with the newest treatments. This gives our patients, especially those for whom standard therapy has failed, the opportunity to receive treatments not otherwise available, which may improve their survival.
Our care approach starts even before diagnosis. 25% of men diagnosed with prostate are diagnosed at a late stage, compared to less than 5% in the USA. We believe that by better educating men on the early symptoms of prostate cancer and options for early diagnosis, we can improve on this.
To that end, we work closely with the Singapore Cancer Society and the Men’s Health charity – the Movember Foundation, to advocate for better public education on Prostate Cancer. The National University Hospital (NUH) is the only healthcare institution to field a team for Movember to raise public awareness and funds for prostate cancer education and research in Singapore.
It can be tough for men and their families dealing with prostate cancer. Treatments can be associated with troublesome side effects, and this may cause anxiety and depression.
We work closely with the Singapore Cancer Society, and actively encourage our patients to join the Prostate Cancer Support Group – The Walnut Warriors. This close knit support group provides a continuing opportunity to learn about the various aspects of the disease, and to share experiences and feelings with others. Most meetings provide an educational programme presented by a professional in the field followed by an open discussion session. Spouses are encouraged to attend most groups.
The Prostate Cancer Treatment Team is spearheaded by Prof Edmund Chiong who is backed by his team of medical professionals across the areas of Medical Oncology, Pathology, Radiation Oncology and Radiology. The team is committed to delivering uncompromised and dedicated clinical research, expertise and care in the prevention, management and cure of Prostate Cancer.