Prostate cancer: Early screenings can save lives

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SINGAPORE - Screening for prostate cancer saves lives, say doctors and cancer survivors.

 

This was the case for retired marine engineer Victor Tay, 68, who learnt he had prostate cancer only after going for a free health screening in 2016.

 

Since there are often no symptoms in the early stages of the cancer, he assumed he was in good health, especially as he was an avid jogger and a swimmer.

 

Mr Tay would not even have gone for a check-up in 2016, had he not read an article in The Straits Times about a free health screening in his area.

 

"I used to think I was healthy and nothing would happen to me," recalls the married father of two grown-up children.

 

"The very first time I learnt about my condition, I had no knowledge of what's happening, the severity of it or the treatment."

 

Mr Tay has been cancer-free since late 2017, after undergoing hormone therapy and surgery. He goes for long walks and swims four times a week.

 

Now a member of the Singapore Cancer Society's Walnut Warriors, a support group for men who have been diagnosed with prostate cancer, he urges other men his age to screen regularly for prostate cancer.

 

"If I had missed that article in the newspaper, it would have been quite risky for me," he says.

 

Prostate cancer affects the prostate gland found in the male reproductive system. It is the second-most common cancer in men in Singapore, after colon and rectum cancer, according to the Singapore Cancer Registry Annual Report 2018.

 

In the early stages, prostate cancer is asymptomatic. By the time a person notices symptoms such as blood in the urine or frequent urination, the cancer may have spread beyond the prostate gland, says Duke-NUS Medical School Associate Professor Ravindran Kanesvaran, who is deputy chairman and senior consultant at the National Cancer Centre's division of medical oncology.

 

"Symptoms of prostate cancer usually show up at later stages of the disease as the tumour grows and narrows the urethra, or urine passage, and spreads to other organs," he says.

 

He adds that early detection boosts chances of successful treatment.

 

Screening for prostate cancer can be important, especially in men over 50. Doctors may recommend starting screening even earlier for those with a family history of prostate cancer in men, or breast cancer in women.

 

Like many other patients with prostate cancer, Mr Tay's condition was detected through a blood test that found he had elevated levels of prostate-specific antigen (PSA). Higher levels of this antigen are found in men with prostate cancer.

 

Further tests, including magnetic resonance imaging (MRI) to observe the extent of the cancer spread and a targeted biopsy to examine tissue from the gland, helped Mr Tay and his doctor decide on the preferred course of treatment.

 

Dr Kanesvaran says there are a range of treatment options based on the patient's age, whether or not he has other underlying health conditions and the stage of cancer.

 

Men with slow-growing, early-stage prostate cancer, who have no symptoms, may choose to have the doctor closely monitor their condition through MRI and PSA tests. They may not opt for treatment unless the test results recommend otherwise.

 

"For patients who are in good health, and the cancer is small and can easily be surgically removed, the doctor may recommend a prostatectomy to remove the prostate and some of the surrounding tissue," he adds.

 

Surgery may have long-term side effects in some patients, including incontinence, or urine leakage, in some patients, and difficulty maintaining an erection.

 

Other treatment options for prostate cancer include radiotherapy. Hormone therapy may be added to improve the results, says Dr Jonathan Teh, senior radiation oncologist at Asian Alliance Radiation & Oncology.

 

"Stage IV prostate cancer is not treated surgically as the cancer has spread outside the area of the prostate. The backbone of stage IV treatment is androgen deprivation therapy injections," he adds.

 

This therapy, known as ADT, reduces the amount of male sex hormones or androgens in the body, since these can promote the growth of prostate cancer cells. There may be side effects such as hot flushes, low sex drive, fatigue and weight gain.

 

Mr Eddie Low, 63, opted for radiotherapy to treat his prostate cancer. He was diagnosed in 2018, a year after he learnt that he had lung cancer and liver cancer.

 

Early detection of the prostate cancer - thanks to regular tests of his PSA levels - has helped him manage treatment for his various conditions.

 

"Early diagnosis makes a difference," says Mr Low, who has retired from his job at a social enterprise in order to focus on his health. He looks forward to eventually rejoining the workforce.

 

Mr Clarence Heng, 66, opted for surgery in January 2016, after he was diagnosed with prostate cancer some months earlier.

 

"I'm a chop-chop kind of person, so I opted to 'chop-chop' and get rid of it," quips the retiree, who used to be part of senior management in a multinational company.

 

He was alerted to the risk of prostate cancer in 2013, during an executive health screening organised by his company. He recommends that men make time for such screenings.

 

Mr Heng also volunteers with the Walnut Warriors group at the Singapore Cancer Society, and was a much-needed listening ear for Mr Tay, during the his recovery.

 

Mr Tay found it helpful to speak with someone who had been through the same thing and who could understand the physical and mental challenges he faced.

 

He remembers his reaction after receiving his diagnosis.

 

"I was gripped by fear and a lot of unwanted thoughts. For the first time, you are confronted by questions like: 'Am I going to die?'"

 

Mr Heng recalls that he too felt fear after he was diagnosed.

 

"But after that, you have to calm down and work closely with the doctor," he says.

 

He speaks openly of the after-effects of surgery such as incontinence. But nine months after the operation, he went on a trip to China to celebrate his recovery. He preserves photos of that trip in an album that charts his cancer journey.

 

"I'm very thankful," he says. "If you have early discovery and early treatment, then you have early recovery."

 

What is prostate cancer?

 

Prostate cancer is the second-most common cancer in men in Singapore, according to the Singapore Cancer Registry Annual Report 2018.

 

The prostate is a walnut-shaped gland found in the male reproductive system. If abnormal cells in the prostate gland grow too rapidly, a malignant or cancerous lump is formed, says at Duke-NUS Medical School Associate Professor Ravindran Kanesvaran, who is deputy chairman and senior consultant at the National Cancer Centre's division of medical oncology.

 

Advanced prostate cancer can spread to other parts of the body, such as the lymph nodes and bones.

 

The chances of successfully treating prostate cancer are enhanced by early detection, when it is still limited to the prostate gland, experts say.

 

What are the treatment options?

 

Dr Kanesvaran says treatment options for prostate cancer include surgery, chemotherapy, radiation therapy and hormone therapy.

 

"The choice of treatment is guided by several factors, including the patient's age, underlying medical health and the presence of co-existing illnesses, stage of cancer, as well as his preference."

 

He adds: "Men with low-grade, early-stage prostate cancer that is slow-growing and causing little or no symptoms may not need immediate treatment. In such cases, they may decide with their doctors to wait and see whether the cancer is progressing before starting any treatment."

 

Who are at risk?

 

Older men and men with a family history of prostate cancer or breast cancer are at higher risk of developing prostate cancer.

 

Mutations in the breast cancer gene BCA2 can contribute to the development of prostate cancer in men, says Dr Tan Teck Wei, a member of the Singapore Cancer Society's Prostate Cancer Awareness Month committee. He is also a consultant urologist at Urohealth Medical Clinic.

 

When should men screen for prostate cancer?

 

Men can consult their doctors on whether they should be screened for prostate cancer. Men who should be considered for screening include those with a family history of breast cancer, who may be recommended to start screening from age 40. Men with a family history of prostate cancer may be considered for screening from age 45 and others may be considered for screenings from age 50.

 

Correction note: This story has been edited for clarity. Men can consult their doctors on whether they should be screened for prostate cancer.

 

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.

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