All About Prostate Cancer Screening

What is prostate cancer?

The prostate gland is a walnut-sized gland that is located below the bladder and in front of the rectum. The prostate gland is part of the male reproductive system, and its main function is to produce prostatic fluid that nourishes the sperms. Its growth is controlled by a male hormone, testosterone.

Prostate cancer occurs due to uncontrolled and excessive cell growth within the prostate gland. In most patients, prostate cancer is generally slow-growing and confined to the prostate gland although there are certain types of prostate cancer that are more aggressive and can be potentially life-threatening if untreated. If they were to spread, prostate cancers tend to spread to the lymphatic system and also to other parts of the body such as the lungs and bone.

In Singapore, prostate cancer is the second most common cancer in males, with almost 6000 cases diagnosed in total from 2015-2019. Prostate cancer made up about 15% of all the cancers diagnosed within this time period among men.

Prostate cancer may present with several symptoms, including

Difficulty passing urine
Weak, interrupted urine stream
Blood in the urine
Loss of weight that is unexplained and unintentional
Loss of appetite
Pain in the back, hips, and other bony areas, such as the arms and thighs

However, most men with early prostate cancers do not experience any symptoms and are asymptomatic.

What is prostate cancer screening?

Cancer screening is a way to help test for cancer in people, usually before the cancer is advanced enough to cause symptoms. It is recommended to speak to a urologist before you take any screening tests for prostate cancer so that you can get a clearer picture of the pros and cons of prostate cancer screening based on your personal risk factors.

What to expect

Given that the first line of screening is a PSA blood test, a simple blood sample will be drawn for you during the screening. Your doctor may also elect to perform a DRE (Digital Rectal Examination), which is a short physical examination of your prostate which would last at most 1-2 minutes.

Prostate-Specific Antigen (PSA) Test

PSA is a protein made by cells in the prostate gland. It is found in semen and also in the blood in small amounts. In literature, high PSA levels are indicative of prostate cancer or other conditions that affect the prostate. However, there is no set cutoff point as of yet to determine whether or not there is prostate cancer, although levels above 4ng/mL are generally considered to be high and warrant further investigation.

Also, note that some factors may cause PSA to be high such as:

enlarged prostate (such as in benign prostatic hyperplasia BPH)
old age
prostatitis (inflammation or infection of the prostate gland)
Prostate cancer
certain urological procedures

It is important to note that elevated PSA levels do not necessarily mean that you have prostate cancer. Your urologist may carry out further investigations or a biopsy to confirm the diagnosis.

Digital Rectal Exam (DRE)

A digital rectum is part of a physical examination of the abdomen. During a DRE, the urologist will insert a gloved, lubricated finger into the anus to feel for any lumps on the prostate. If there is a lump felt, you may be sent for further investigation.

If you have any conditions such as haemorrhoids, anal fissures or anal tears, please let your urologist know, as these conditions may cause discomfort or pain during the examination.

These tests do not conclusively determine the presence of prostate cancer. However, if anomalies are present in your evaluation, your urologist may recommend further tests, such as an MRI of your prostate or a prostate biopsy for a definitive diagnosis.

Who should go for prostate cancer screening?

Generally, prostate screening is not recommended as part of national cancer screening guidelines. Some groups of men may be at higher risk of prostate cancer, such as men with a known history or likely carriers of the BRCA1 or BRCA2 genetic mutations, those with Lynch syndrome, and men with a family history of prostate cancer. However, PSA remains one of the only ways to screen for prostate cancer, as most early prostate cancer patients are asymptomatic. Do speak to your urologist if you are keen to screen for prostate cancer.

Prostate cancer treatments

Treatment for prostate cancer largely depends on its risk classification and the stage of the cancer. This can range from conservative measures, such as active surveillance, to more radical modalities, such as surgeries that involve the removal of the prostate.

In its early stages, prostate cancer is curable. This means that early detection and diagnosis translates to earlier treatment and better chances of making a full recovery. Studies have shown that there is a 95-99% 5-year survival rate in men who were diagnosed with low and intermediate prostate cancer while it is localised. This percentage drops to 31% when the prostate cancer has spread to other parts of the body.

Can prostate cancer be prevented?

There are currently no proven prevention strategies for prostate cancer. Adopting a healthy lifestyle, however, may help improve your overall health and also ensure that your medical comorbidities are well-controlled. This includes at least 30 minutes of exercise 5 days a week, smoking cessation, eating a healthy diet, and consuming alcohol in moderation.

Summary

In conclusion, it may still be worthwhile to speak to a urologist in Singapore if you are concerned about your risk profile, especially if you have a family history of cancer or experience symptoms that may suggest a prostate-related condition. Given its prevalence in the Singaporean male population, it is prudent to be aware of prostate health and to know and identify any red flags present.

Thankfully, there are a variety of treatment modalities for prostate cancer. Advancements in technology have even brought about minimally invasive procedures, such as robotic prostatectomy, to treat prostate cancer without having to undergo open surgery. Dr Terence Lim will work with you in finding the right treatment plan for you.