Prostate Cancer or Not


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Dr Ho Siew Hong delivered a public lecture on differentiating prostate cancer from non cancer enlargement of the prostate during the Prostate Awareness Month 2008

Published in: Health & Medicine
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    To learn more about IPSS (International Prostate Symptom Score) online check which is very reliable to pre-diagnose prostate disorders at early stage -
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  • Prostate Cancer or Not

    1. 1. Cancer or Not Cancer ? Dr Ho Siew Hong Consultant Urologist S H Ho Urology and Laparoscopy Centre Gleneagles Hospital
    2. 2. Location of Prostate Gland <ul><li>Below urinary bladder </li></ul><ul><li>Encircles urethra </li></ul><ul><li>About 25 gm, size of ‘ciku’ </li></ul>
    3. 3. Function of the Prostate Gland <ul><li>Production of seminal fluid </li></ul><ul><li>Supplies nutrition to the sperm </li></ul><ul><li>Without this fluid, the sperm would not survive their journey </li></ul>
    4. 4. What happens to the prostate when we get old? <ul><li>Prostate gland begins to age at about age 40-45 years </li></ul><ul><li>Grows in size </li></ul><ul><li>Cancer change </li></ul>
    5. 5. How common are Prostate problems? <ul><li>‘ There is an old saying that if you are a man and live long enough, you will eventually have problems with your prostate’ </li></ul><ul><li>‘ Prostate enlargement is the commonest growth in the elderly men’ </li></ul><ul><li>’ In men above 50 years of age, up to half may have prostate enlargement’ </li></ul>
    6. 6. Problems with an ‘Old Prostate’ <ul><li>Benign Prostatic Hyperplasia (BPH) - enlargement and obstruction </li></ul><ul><li>Cancer of the Prostate </li></ul><ul><li>Infection </li></ul><ul><li>Inflammation </li></ul>
    7. 7. Benign Prostatic Enlargment <ul><li>BPH, BPE </li></ul><ul><li>Very common </li></ul><ul><li>Part of aging </li></ul><ul><li>Results in squeezing of the urine tube </li></ul>
    8. 8. How do I know if I have a Prostate problem? <ul><li>Urination problems - Poor flow - Straining - Frequency - Incontinence - Passing more than 2 times in night </li></ul>
    9. 9. Complications <ul><li>Urine infection </li></ul><ul><li>Urine stone </li></ul><ul><li>Complete urine blockage </li></ul><ul><li>Kidney failure </li></ul>
    10. 10. Prostatitist <ul><li>Pain is the main feature </li></ul><ul><li>Burning sensation during passage of urine </li></ul>
    11. 11. Cancer of the Prostate <ul><li>Less common in Singapore </li></ul><ul><li>Risk increases with age </li></ul><ul><li>Usually does not cause much symptoms till cancer is advanced </li></ul>Cancer
    12. 12. Symptoms of early Prostate Cancer <ul><li>No pain, </li></ul><ul><li>No urine complain </li></ul><ul><li>No blood in urine </li></ul>
    13. 13. Other signs of Cancer <ul><li>Tiredness, lethargy </li></ul><ul><li>Anaemia </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Loss of weight </li></ul><ul><li>Bone pain </li></ul>
    14. 14. Risk of cancer <ul><li>Family history of prostate cancer </li></ul><ul><li>Smoking </li></ul><ul><li>? Western diet </li></ul><ul><li>Not related to prostate enlargement, infection, sexual activities </li></ul>
    15. 15. What should I do ? <ul><li>Awareness </li></ul><ul><li>Early action </li></ul><ul><li>No self examination method </li></ul><ul><li>No lump to be felt </li></ul><ul><li>Consult a doctor </li></ul>
    16. 16. Other methods to detect cancer <ul><li>Detail history </li></ul><ul><li>Current medications </li></ul><ul><li>Simple abdominal examination </li></ul><ul><li>Examination of the prostate (by inserting a gloved finger into the back passage) </li></ul>
    17. 17. Digital Rectal Examination Nodule Consistency
    18. 18. Tests to detect Cancer <ul><li>PSA (Prostate Specific Antigen) - simple blood test - no preparation required - cancer marker - normal <4.0 ug/dL </li></ul>‘ 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’
    19. 19. Transrectal Ultrasound and Biopsy
    20. 20. Transrectal Ultrasound and Biopsy
    21. 21. PAW 2004 Singapore <ul><li>Informed consent form </li></ul><ul><li>Answer IPSS and IIEF-5 forms </li></ul><ul><li>Blood for serum total PSA </li></ul><ul><li>No DRE </li></ul><ul><li>Those with elevated serum total PSA (>4 ng/dl) advised TRUS-guided biopsy of the prostate </li></ul>Cancer detection rate (based on serum total PSA): 1.2 % (43/3415)
    22. 22. Why detect prostate cancer early? <ul><li>Early cancer is potentially curable </li></ul><ul><li>Cure by surgery or radiation </li></ul><ul><li>15 year survival (expected to be a live) - 65% (cancer specific survival 90%) </li></ul><ul><li>If not treated, 15 year survival - 35% (cancer specific survival 80%) </li></ul>
    23. 23. Strategy <ul><li>Awareness </li></ul><ul><li>Do not deny symptoms </li></ul><ul><li>Do not accept symptoms as part of aging </li></ul><ul><li>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 </li></ul>
    24. 24. Thank you