10 things to know about prostate cancer

Prostate cancer occurs four times more frequently compared to 30 years ago, and is now the fifth most common cancer in Singapore, according to a SingHealth report.

Here are ten things that you need to know about the cancer, based on a booklet on prostate cancer by the National Cancer Institute.

1. What is the prostate?

It is part of a male’s reproductive system that is located in front of the rectum and under the bladder. It surrounds the urethra, which is the urinary tract.

For a healthy male, the size of a healthy prostate is about the size of a walnut. If it grows too big, it will squeeze the urethra, which may cause slowness or stopping of the normal flow of urine.

The prostate is also an important part during sexual intercourse. As the prostate is a gland, it makes up part of the seminal fluid, which, during orgasm, helps carry sperm out of the man’s body as part of semen.

2. Cancer cells in the prostate

Growth in the prostate can be benign, which means it’s not cancer.

Benign growths, like benign prostatic hypertrophy, for example, are rarely a threat to life. They cause no harm to the tissues around the growth because they do not invade them. They also do not spread to other parts of the body and can be removed. In most cases, the growths do not usually grow back.

On the other hand, malignant growths, which are known as prostate cancer, may sometimes be a threat to life as they can invade organs and tissues that are near to it, such as the bladder or rectum. The growth can also spread to other parts of the body but can often be removed. However, the growth can sometimes grow back.

Prostate cancer cells can spread and travel through blood vessels or lymph vessels to other parts of the body. They may attach to other tissues and form new tumors.

3. Stages of prostate cancer

The different stages of prostate cancer is described using the Roman numerals, I, II, III and IV. Stage I is early-stage cancer and Stage IV cancer is advanced cancer that has already spread to other parts of the body.

4. Treatment of prostate cancer

There are various treatment options for males with prostate cancer. They include:

• Active surveillance

• Surgery

• Radiation Therapy

• Hormone Therapy

• Chemotherapy

• Immunotherapy

Males may receive more than one type of treatment, as the treatment that’s best for one man may not be so for another. The best treatment for each male depends on:

• Age

• Gleason score of the tumor

• Prostate cancer stage

• Symptoms

• General health

5. Surgery

Treatment of prostate cancer through surgery is an option for males with early-stage cancer that is only in the prostate. Males with advanced prostate cancer may also consider this option to relieve symptoms.

The surgeon will usually remove the entire prostate and nearby lymph nodes using several ways:

a)    A large cut in the abdomen: The prostate is removed through a long incision in the abdomen below the belly button. This is known as radical retropubic prostatectomy. As there is a long cut, it’s also called an open prostatectomy.

b)   Small cuts in the abdomen: Several small cuts are made in the abdomen, and surgery tools are inserted through the small cuts. A long, thin tube (called laparoscope) with a light and camera on the end would aid the surgeon in seeing the prostate while removing it. This process is called a laparoscopic prostatectomy.

c)    With a robot: This way of surgery uses a robot to remove the prostate through small cuts in the abdomen. The surgeon then uses handles on a computer display to control the robot’s arms.

d)   A large cut between the scrotum and anus: The prostate is removed through a cut between the scrotum and anus. This is called radical perineal prostatectomy. This type of surgery is a type of open prostatectomy that is rarely used anymore.

6. After surgery

Some males may lose control of the flow of urine after surgery, known as urinary incontinence. In most cases, males regain some bladder control after a few weeks. However, for some males, incontinence may be permanent.

7. Performance during sexual intercourse

Surgery may also damage nerves near the prostate and cause erectile dysfunction. Sexual function typically improves over several months, but for some males, this problem can be permanent.

If the males had their prostates removed, they will have dry orgasms where semen will no longer be released.

A Swiss research conducted on both members of a couple find that performance in sexual intercourse may not be optimized as both members may experience less than expected sexual function after a man has prostate cancer surgery.

The study was done on sexual function and satisfaction of males who had a type of cancer surgery to remove the entire prostate, including the semen glands, but nearby nerves involved in erections are protected.

The study was conducted on females as well and most found they had decreased sexual function after the males had surgery, with a drop in desire, arousal, lubrication, orgasm and satisfaction.

8. Specialists in treating of prostate cancer

When diagnosed with prostate cancer, it is best to be aware of who the specialists are in treating of the prostate problems:

Urologist
A doctor specializing in treating problems in the urinary tract or males sex organs. The doctor can also perform surgery.

Urologic oncologist
A doctor specializing in treating cancers of the male and female urinary tract and the male sex organs. The doctor can also perform surgery.

Medical oncologist
A doctor who specializes in treating cancer with drugs, such as chemotherapy, hormone therapy or immunotherapy.

Radiation oncologist
A doctor who specializes in treating cancer with radiation therapy.

9. Nutrition

Eating well is important before, during and after cancer treatment. Males with prostate cancer should check with their doctor regarding the foods that patients can eat that can help with side effects.

10. Questions to ask

When in doubt, ask. For males who are diagnosed with prostate cancer, they should ask their doctors to clarify any doubts so as to have the best idea of what they may be expecting.

Here are some questions that may be possible to ask about treatment options:

• What are the expected benefits of each kind of treatment?

• What are the risks and possible side effects of each treatment? How can the side effects be managed?

• What can I do to prepare for treatment?

• How will treatment affect my normal activities?