Prostate Cancer
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Overview
 What is Prostate Cancer?
The prostate is a small gland located below the bladder and found only in men. It surrounds part of the urethra that allows the passage of urine from the bladder to the penis. The cells that make up the outermost part of the prostate can become cancerous and give rise to prostate cancer.
How common is Prostate Cancer?
Prostate Cancer is the third most common cancer in men. This cancer usually occurs after the age of 50 years and is seen mostly in those over 70 years of age.
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Causes and Risks
There is no single cause of prostate cancer. It is thought that smoking and family history are among the contributory factors.
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Symptoms
Symptoms and Signs of Prostate Cancer
Early prostate cancer is usually without symptoms and may be picked up incidentally during a routine examination of the rectum. With more advanced disease there may be difficulty passing urine. The cancer can spread to any organ or tissue in the body with the most common site of spread being the bone. As such a common symptom is bone pain.
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Diagnosis
Diagnostic Tests
The prostate is located in front of the rectum. It can therefore be examined with a gloved finger in the rectum by a doctor. Apart from physical examination, blood tests (Prostate specific antigen or PSA) help to diagnose prostate cancer. To confirm prostate cancer, small pieces of tissue from the prostate gland are removed, and examined under the microscope. In order to find out the extent of prostate cancer, CT or MRI scans are performed. A bone scan is also done to see if the bones are affected as this is the most common site of spread.
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Treatment Options
Treatment of Prostate Cancer
Some cases of localized prostate can be managed with active surveillance1. Surgery for prostate cancer involves removal of the entire prostate gland and nearby tissue. There may be complications after surgery such as impotence and difficulty controlling urine because delicate nerves may be damaged during the procedure.
Radiation therapy is the use of high-energy rays focused on the cancer. It has an important role to play in the treatment of prostate cancer. Radiotherapy may be used instead of surgery for early prostate cancer2. It may also be given to patients with advanced cancer that has spread to the bones, to relieve pain.
Prostate cancer depends on male sex hormones to grow; therefore blocking the production of male sex hormones is one strategy to control the growth of prostate cancer. This can be achieved with drugs (hormonal therapy) or removal of both testes (bilateral orchidectomy). Some male hormones come from the adrenal glands, small glands that sit on top of the kidneys. There are agents that can stop the production of these hormones from the adrenal glands. When hormonal therapy no longer works in patients with advanced prostate cancer, chemotherapy may be used3.
Prognosis of Prostate Cancer
Clinical examinations scans and pathology reports all help the medical team to decide what the progress of prostate cancer is. The appropriate course of treatment may then be recommended. The treatment strategy will vary from person to person. Prognosis of prostate cancer depends on the extent of the disease, the state of health of the individual as well as response to treatment.
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Frequently Asked Questions
Why was my 85-year old father / uncle not treated for his prostate cancer?
Treatment is occasionally not given to the elderly patient with slow-growing prostate cancer. The patient may have other diseases that are potentially life threatening, such as heart disease or lung disease. His cancer, if left alone, may not cause problems for many years to come1.
What tests should be done to detect prostate cancer?
Blood can be sent for prostate specific antigen or PSA. This marker may be elevated in people who have a benign enlargement of the prostate gland, infection of the prostate gland or prostate cancer.
What are methods to prevent getting prostate cancer?
Currently there are no proven preventive strategies. In general, living a healthy lifestyle, eating a healthy balanced diet and stopping smoking are helpful. If you notice symptoms, consult a doctor at the earliest opportunity. Symptoms may include frequent urination, painful urination, increased urination at night, blood in the urine, and difficulty starting and maintaining a steady flow of urine.
Is prostate screening advised and if so at what age should it be started?
Based on recent large population based studies, at present there is a lack of evidence to support a population based screening for prostate cancer in Singapore. Patient should seek medical attention should there be symptoms as suggested above. |
References:
1. Thompson I, Thrasher JB, Aus G, et al. Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007; 177:2106.
2. Kupelian PA, Potters L, Khuntia D, et al. Radical prostatectomy, external beam radiotherapy <72 Gy, external beam radiotherapy > or =72 Gy, permanent seed implantation, or combined seeds/external beam radiotherapy for stage T1-T2 prostate cancer. Int J Radiat Oncol Biol Phys 2004; 58:25.
3. Tannock IF, de Wit R, Berry WR, et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 2004; 351:1502. |
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