Prostate Cancer or Not

Cancer or Not Cancer ? Dr Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital

Location of Prostate Gland
Below urinary bladder
Encircles urethra
About 25 gm, size of ‘ciku’

Function of the Prostate Gland
Production of seminal fluid
Supplies nutrition to the sperm
Without this fluid, the sperm would not survive their journey

What happens to the prostate when we get old?
Prostate gland begins to age at about age 40-45 years
Grows in size
Cancer change

How common are Prostate problems?
‘ There is an old saying that if you are a man and live long enough, you will eventually have problems with your prostate’
‘ Prostate enlargement is the commonest growth in the elderly men’
’ In men above 50 years of age, up to half may have prostate enlargement’

Problems with an ‘Old Prostate’
Benign Prostatic Hyperplasia (BPH) - enlargement and obstruction
Cancer of the Prostate
Infection
Inflammation

Benign Prostatic Enlargment
BPH, BPE
Very common
Part of aging
Results in squeezing of the urine tube

How do I know if I have a Prostate problem?
Urination problems - Poor flow - Straining - Frequency - Incontinence - Passing more than 2 times in night

Complications
Urine infection
Urine stone
Complete urine blockage
Kidney failure

Prostatitist
Pain is the main feature
Burning sensation during passage of urine

Cancer of the Prostate
Less common in Singapore
Risk increases with age
Usually does not cause much symptoms till cancer is advanced
Cancer

Symptoms of early Prostate Cancer
No pain,
No urine complain
No blood in urine

Other signs of Cancer
Tiredness, lethargy
Anaemia
Loss of appetite
Loss of weight
Bone pain

Risk of cancer
Family history of prostate cancer
Smoking
? Western diet
Not related to prostate enlargement, infection, sexual activities

What should I do ?
Awareness
Early action
No self examination method
No lump to be felt
Consult a doctor

Other methods to detect cancer
Detail history
Current medications
Simple abdominal examination
Examination of the prostate (by inserting a gloved finger into the back passage)

Digital Rectal Examination Nodule Consistency

Tests to detect Cancer
PSA (Prostate Specific Antigen) - simple blood test - no preparation required - cancer marker - normal <4.0 ug/dL
‘ A high PSA does not necessarily mean that you have cancer of the prostate but it usually means that there is some problem with the prostate’

Transrectal Ultrasound and Biopsy

PAW 2004 Singapore
Informed consent form
Answer IPSS and IIEF-5 forms
Blood for serum total PSA
No DRE
Those with elevated serum total PSA (>4 ng/dl) advised TRUS-guided biopsy of the prostate
Cancer detection rate (based on serum total PSA): 1.2 % (43/3415)

Why detect prostate cancer early?
Early cancer is potentially curable
Cure by surgery or radiation
15 year survival (expected to be a live) - 65% (cancer specific survival 90%)
If not treated, 15 year survival - 35% (cancer specific survival 80%)

Strategy
Awareness
Do not deny symptoms
Do not accept symptoms as part of aging
Routine medical check up - 2 to 3 yearly if between 40 - 50 years old - annual if above 50 years old - annual PSA test if family history of prostate cancer

Thank you

Prostate Cancer or Not

by Siewhong Ho on Aug 30, 2008

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