SPONSORED FEATURE

Detecting prostate cancer at an early stage Early-stage prostate cancer has few or no symptoms as the cancer develops relatively slowly . If symptoms appear , they may include difficulty in passing urine , slow urine �ow , fre�uent urination and blood in urine .

There is currently no established screening programme for the early detection of prostate cancer in Singapore . Screening usually utilises the prostate specific antigen ( �SA ) blood test to determine the risk of having prostate cancer . �en who may benefit from screening after counselling include those at elevated risk of having prostate cancer :

• Men from 50 years or age .

• Men from 45 years of age and a family history of prostate cancer ;

• Men of African descent from 45 years of age ;

• Men carrying BRCA2 mutations from 40 years of age .

Treatment options for early-stage prostate cancer In early-stage prostate cancer , or cancer localised to the prostate , the treatment options are mainly in�uenced by the grade ( or aggressiveness ) of the cancer .

In active surveillance , patients are monitored closely and treatment such as surgery or radiation therapy is deferred unless there is growth or progression of cancer . This approach is only applicable to a small proportion of low-grade cancers .

Surgery involves removing the prostate and the surrounding tissues completely . This includes removal of the surrounding lymph nodes , especially for high-grade cancers . The gold standard surgical option nowadays is robot-assisted radical prostatectomy . Two of the main long-term side effects of surgery are erectile dysfunction and urinary incontinence .

Radiation therapy involves utilising high doses of radiation to kill prostate cancer cells . The most commonly used type of radiation therapy for prostate cancer is called e�ternal beam radiation therapy ( �B�T ), in which a machine aims radiation at the cancer from outside the body . It is considered as effective as surgery for the treatment of localised prostate cancer , and is the standard alternative in all the prostate cancer treatment guidelines . Potential downsides to radiation therapy include longer treatment duration and risk of damage to surrounding organs .

With the advent of more accurate MRI-targeted prostate biopsies in the last few years , some patients are diagnosed with cancer only involving a small proportion of the prostate . In these men , the logical thought is whether treatment can be focused only on these areas of cancer without needing whole gland treatment . This is also known as focal therapy as only the region of the prostate where the cancer is located is treated . This approach can potentially improve the functional outcomes of treatment ( i . e ., lower the risk of urine incontinence and erectile dysfunction ) without sacrificing control of the cancer that is achieved with whole gland treatment . Focal therapy is a new approach to treating prostate cancer , and as such the studies have follow up of less than 10 years after treatment . However , it is still not considered standard of care and more information is needed about long term outcomes from this approach .

�r Akhil Chopra is a senior consultant in medical oncology practicing at the �ncoCare Cancer Centre ( Singapore ). He has a special interest in Genitourinary oncology , especially prostate cancer .

�r Tan Teck �ei is a Senior Consultant �rologist at �rohealth �edical Clinic ( Singapore ). He has a special interest in the management of urological cancers , and completed a fellowship in Robotic surgery and �ro-oncology at Guy ’ s and St Thomas ’ Hospitals in �ondon , �nited �ingdom .

GlobalHealthAsiaPacific . com ISSUE 1 | 2023

29