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Understanding Prostate Cancer: Causes, Symptoms and Treatments

Prostate cancer is a type of cancer that develops in the prostate gland in men. The size of a walnut, the gland is situated below the bladder and it encloses a part of the urethra which facilitates urine flow from the latter to the penis.

According to the Singapore Cancer Registry’s Interim Annual Report: Trends in Cancer Incidence in Singapore 2010-2014, it is the third most frequent cancer and the sixth-most frequent cancer that causes death in males. By ethnicity, prostate cancer is ranked at No. 2 among Indians, No. 3 among Chinese, and No. 4 among Malays. Other sources have also included the Africans. In the Singapore Cancer Registry’s study, the increase in diagnosed cases and survival rates of prostate cancer has been attributed to the advent of Prostate Specific Antigen (PSA) testing, which allows for early diagnosis of the disease.


Causes and Risk Factors of Prostate Cancer

The exact causes of prostate cancer remain unidentified. However, there are a number of known factors that will increase the risk of prostate cancer.

These risk factors include the following…

  • Age = there is an increased risk of prostate cancer after 50 years old
  • Race or ethnicity = dark-skinned men have a higher risk of developing prostate cancer
  • Family history of prostate cancer, especially in first-degree relatives such as fathers or brothers
  • Diet = there is an increased risk of prostate cancer among males who are obese and consume a high-fat, low-fiber diet
  • Smoking = the increased risk has been attributed to carcinogen exposure and the effects of substances in cigarettes that interfere with hormone levels
  • Testosterone therapy = high levels of testosterone can increase prostate cancer risk
  • Exposure to cadmium and other harmful substances in the workplace

There is still some conflict on vasectomy as a risk factor for prostate cancer. Although numerous studies have demonstrated no identifiable link between vasectomies and prostate cancer, a March 2017 study published in the Journal of Clinical Oncology found a very small increased risk for low-intermediate grace prostate cancer in vasectomised men.


Signs, Symptoms and Diagnosis of Prostate Cancer

Early-stage prostate cancer is sometimes undetected because it does not present with any symptoms. In fact, many of these cancers are accidentally identified when a lump, an enlarged prostate, or changes in texture and other abnormalities are palpated through digital rectal examination (DRE).

In the late stages, prostate cancer is revealed by urinary tract symptoms including…

  • Difficulty in urination (the patient urinates but his bladder still feels full, and that the emptying of bladder is incomplete)
  • The flow of urine slows down to a trickle
  • Frequent urination, including at night so that it interferes with sleep
  • Decreased force in the urine stream
  • Blood in the urine and/or semen

In advanced stages, the symptoms of prostate cancer are related to the areas of the body where it has spread…

  • If cancer has spread to the bones, the patient will experience bone pain, fractures, and spinal compression.
  • If cancer has spread to the lymph nodes, he will feel leg discomfort or swelling

Upon discovering abnormalities of the prostate glance through DRE, the doctor will order Prostate-Specific Antigen (PSA) testing.The prostate gland generates PSA in order to manage the flow of semen. Elevated levels of PSA will require additional investigation.

Diagnostic procedures that will be ordered include transrectal ultrasound and prostate biopsy. If metastasis or spread of the prostate cancer is suspected, any of the following tests may be ordered…

  • Ultrasound
  • Bone scan
  • CT scan
  • MRI
  • Lymph node biopsy


Treatment of Prostate Cancer

Since some prostate cancers grow and spread slowly, active surveillance is done in patients with low-risk localised prostate cancer. This is especially done in elderly men with more serious cancers or in those who have multiple illnesses, such as heart disease and other chronic diseases.

At early-stage treatments, the doctor has the option to perform radiotherapy for localised cancer or surgery, especially if there is a risk of spread. Prostatectomy is the complete removal of the prostate gland and surrounding tissues. This surgery is not without its complications. Damage to nerves during the procedure may lead to urinary incontinence and impotence.

In the late stages, hormonal therapy or the removal of the testes (bilateral orchidectomy) is done to block male sex hormone production, which causes the cancer to grow and spread. Chemotherapy is ordered when hormone therapy does not work. When the cancer has spread to the bones, radiation therapy is given to alleviate bone pain.




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