Prostate Cancer

What is Prostate Cancer?

In most cases, prostate cancer usually grows slowly which means that it takes a number of years to become large enough to be detected. In fact, there have been a number of autopsy studies which have shown that men who died of other non-cancer causes have had prostate cancer. The cancer showed no symptoms, was not detected by their doctors and more importantly, never affected them during their lives.

The prostate gland is usually located underneath the bladder, in front of the rectum and surrounds the urethra. The prostate gland is the size and shape of a walnut and grows bigger as you get older. Only men have a prostate gland and the main function of the gland is the production of semen. The muscles of the prostate also ensure that the semen is forcefully pressed into the urethra and then expelled outwards during ejaculation.

Besides cancer, the prostate gland may cause two other common men health problems:

• Benign enlargement of the prostate (BPH, or benign prostatic hyperplasia), one of the most common benign tumours in men and a source of symptoms for most men as they age
• Prostatitis, painful inflammation of the prostate, the most common cause of urinary tract infections in men

Both these prostate problems are common in men after age 50, and fortunately, effective treatment and relief of symptoms is easily available.

While early prostate cancer rarely causes any typical symptoms, it is recommended that men after 50 should speak to their doctors about the need for a prostate exam. According to the National Cancer Registry, prostate cancer is the fourth most common male cancer in Malaysia, accounting for 5.7 per cent of cancer cases among men.

Symptoms

Prostate cancer that is contained inside the prostate (localised prostate cancer) doesn't usually cause any symptoms. But there have been instances where patients have experienced urinary problems. These may be mild and happen over the course of many years. It is important to note that, these symptoms may also be a sign of a benign prostate problem, rather than prostate cancer.

Prostate cancer symptoms only begin to show once the cancer has grown large enough to put pressure on the urethra. It is best to consult with a doctor or urologist, who are trained to recognise the signs and symptoms of prostate cancer.

Symptoms for prostate cancer usually result in problems associated with urination, such as:

• needing to urinate more frequently, often during the night
• needing to rush to the toilet
• difficulty in starting to pee (hesitancy)
• straining or taking a long time urinating
• weak flow when you urinate
• feeling that your bladder has not emptied fully
• dribbling urine after you finish

Less common symptoms include

• pain when urinating
• pain when ejaculating
• blood in your urine or semen*
• problems getting or keeping an erection – this isn't a common symptom of a prostate problem and is more often linked to other health conditions such as diabetes or heart problems.

*Blood in your urine or semen can be caused by other health problems.

Symptoms that the cancer may have spread include bone and back pain, loss of appetite, pain in the testicles and unexplained weight loss.

Detection and diagnosis

Prostate cancer is usually diagnosed through the following methods:

• A Prostate Specific Antigen blood test
• Physical examination by a doctor

Prostate Specific Antigen (PSA) Test

This simple blood test measures the amount of prostate specific antigen (PSA) in a patient's blood. PSA is a protein produced by the prostate and all men have a small amount of PSA in their blood, which increases with age. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer. Depending on the result, further investigation by a specialist will be needed. Please note that a high PSA test result does not necessarily mean cancer.

Prostate Examination

The examination to check the condition of the prostate is via the rectum. The examination involves inserting a gloved, lubricated finger into the rectum to check the size of the prostate and assess if there are any abnormalities.

Surgery: Radical Prostatectomy with the da Vinci Surgical System

Surgery may be a treatment option for men with prostate cancer who are otherwise fit and healthy. Compared to the traditional treatment which involves large incisions and post-operative side effects, the da Vinci Surgical System allows to shorter hospital stays with minimal blood loss post-op infections. The da Vinci Surgical System uses finely controlled robotic instruments to perform the prostatectomy safely, while enhancing patient recovery and outcome. Treating prostate cancer with the da Vinci Surgical System spares a patient's delicate prostate nerves that control bladder and sexual function.

Radiation Therapy

Radiation Therapy directs high energy X-ray beams at the prostate gland. These beams damage the cells and stop them from dividing and growing. Radiotherapy treats the whole prostate and sometimes the area around it. The treatment is painless but it can cause side effects. Radiation therapy is also used if the cancer is not removed completely or recurs in the area of the prostate after surgery. The two types of radiation therapy used for prostate cancer are external beam radiation and Brachytherapy (or internal radiation). To read more on the different types of radiation treatments available please click here.

It's important to discuss all of your treatment options with your doctors to help make the decision that best fits your needs.

Hormone Therapy

Hormone therapy is also called androgen suppression therapy. The goal is to reduce levels of male hormones, called androgens, in the body, to stop them from fuelling prostate cancer cells. The hormone therapy alone does not cure prostate cancer.