What you should know about prostate problems
Perhaps you have recently noticed an urgent need to urinate more frequently, especially at night. Even though you have the urge, you find it is difficult to start urination, or the flow of urine comes out weak or interrupted. Occasionally, you lose control and the urine flows out before you reach the washroom. You may need to empty the bladder again soon after doing so, or you experience a painful or burning sensation upon urinating, or you notice blood in your urine or semen.
You should consult with your doctor if you experience any of the symptoms above. As these symptoms can also indicate the presence of other disorders, such as non-cancerous prostate enlargement (Benign Prostatic Hypertrophy - BPH) or prostatitis, undergoing a thorough check up will help determine the underlying cause.
However, not everyone with prostate cancer may experiences symptoms, so speak to your urologist about early detection.
Early detection
Increased public awareness and compliance with serum prostate specific antigen (PSA) screening have resulted in prostate cancer being diagnosed at earlier stages over the past decade, so much so that most patients are diagnosed nowadays with early prostate cancer rather than late stage disease. Treatment for early prostate cancer when started early will give you the best chance of improved outcomes.
When to start screening
When to start screening is generally based on individual risk depending upon age, family history and genetic predisposition.
In Singapore, the otherwise healthy male with lower urinary tract symptoms (LUTS), PSA testing can be considered starting from age 50. For individuals with higher risk of prostate cancer due to strong family history of prostate cancer, age 40 is a reasonable time to start screening.
Initial screening involves the urologist performing digital rectal examination (DRE) and PSA blood test. In patients who have suspicious findings on these tests, a prostate biopsy may be offered where tissue samples from the prostate are retrieved for microscopic examination to look for cancerous cells. This is the best test to distinguish between prostate cancer and non-cancerous conditions.
In general, all men should speak to their urologist to create a proactive prostate health plan that is right for them based on their medical history, lifestyle and family history.
Treatment
You should learn as much as possible about the many treatment options available and, in conjunction with your urologist, make a decision about what is best for you.
A surgical approach to treating prostate cancer will remove all of the prostate gland. Typically, men with early-stage disease or cancer that's confined to the prostate will undergo radical prostatectomy—removal of the entire prostate gland, plus some surrounding tissue. Other surgical procedures may be performed on men with advanced or recurrent disease.
Today, prostate cancer patients can choose to undergo laparoscopic robotic surgery. Compared to traditional open surgery, this new approach is minimally invasive, enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision. For the patient, it is also easier to recover from, with improved and early return of sexual function and continence, as well as better surgical outcomes for effective cancer control.
For qualified candidates, robotic-assisted laparoscopic prostatectomy offers numerous potential benefits over traditional open prostatectomy, including shorter hospital stay and recovery time, significantly less pain, less risk of infection, lesser blood loss and fewer transfusions, less scarring and a faster return to normal daily activities.
The writer is a consultant and the head of the Department of Urology at Tan Tock Seng Hospital
