Treatment Options for Prostate Cancer

Early detection, more treatment options

The prostate is important to the male reproductive system for its production of seminal fluid. It may be a small walnut sized gland tucked inconspicuously below the bladder but prostate cancer is the fifth most common cancer among Singaporean men. Those at risk are usually over 55 years old, have a family history of prostate cancer or have a diet high in animal fat and red meat.

As the main urology referral centre in Singapore, SGH registered 217 new patients diagnosed with prostate cancer last year. The numbers are expected to rise in future although that is not necessarily a bad thing as Dr Lau explained. “Based on findings from our own departmental database, 50 to 60 per cent of patients came to us with advanced stages of prostate cancer over the past 15 to 20 years. The cancer cells have spread to the bones so doctors can only try to relieve the patients’ symptoms, not prolong their longevity. But the increase in public awareness and health screenings mean that more cancers that we detect today are in their early stages. The patients are also younger and healthier at about 55 to 60 years old compared to the median age of late 60s in the past. This enables us to offer them more treatment options.”

Multiple treatment options

Prostate cancer is a slow-growing disease so early detection can improve chances of recovery. Treatment is based on how advanced the cancer is, the patient’s age and general health.

Treatment	What it is
Brachytherapy	Hollow needles are used to insert radioactive seeds into the prostate gland near the tumor to emit low-dose radiation to kill cancer cells over six to seven months. About 20 to 25 needles are used to insert 80 to 100 seeds, depending on the size of the prostate gland.
External beam radiation	High energy X-rays are used to kill cancer cells. The therapy is conducted over seven weeks.
Open radical prostatectomy	Open surgery to remove the whole prostate gland and nearby lymph nodes.
Da Vinci robotic-assisted laparoscopic radical prostatectomy	Robotic surgery where the prostate is removed with five or six tiny incisions. Robotic arms enter these holes with a camera and surgical instruments. SGH’s Urology Centre was the first in South East Asia to offer this option.
Hormone therapy	Lowers the level of male hormones such as testosterone using injections or oral medication as they fuel cancer growth.
Continuous observation	Patient does not undergo any active treatment. Instead, the doctor monitors the patient’s condition with regular Prostate Specific Antigen (PSA) blood tests, biopsies and rectal exams.

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