Prostate cancer: Busting the myths

Prostate cancer is the most common cancer among men in Singapore, with over 7,500 cases diagnosed from 2018 to 2022¹.  While most cases are in men over the age of 50, misinformation remains a major barrier to early detection and timely treatment. 

Dr Jeffrey Tuan, Senior Consultant and Research Director of the Division of Radiation Oncology, NCCS, debunks common prostate cancer myths to help patients make informed decisions about their health.

To celebrate Prostate Cancer Awareness Month this September, Dr Jeffrey Tuan, Senior Consultant and Research Director of the Division of Radiation Oncology, National Cancer Centre Singapore (NCCS), debunks common myths and shares tips for men to take care of their health.

Myth 1: Only older men get prostate cancer

Fact: While it is more common in older men, prostate cancer does affect younger men, especially those with a family history. The risk increases after the age of 50, and men with a father or brother with prostate cancer are more likely to be diagnosed with the disease. 

What you can do:

• Know your family history and share it with your doctor.

• If you are at a higher risk, discuss screening options with your doctor from the age of 45. 

• Stay healthy with regular exercise, a balanced diet and limited consumption of alcohol and fatty food.

Dr Tuan advises men who experience recurring symptoms, like difficulty urinating, to seek medical attention early for prompt diagnosis and treatment. 

Myth 2: If I have trouble urinating, it means I have prostate cancer

Fact: Not always. Difficulty while urinating is often caused by a non-cancerous condition called benign prostate hyperplasia (BPH). While prostate cancer can present with similar symptoms in later stages, early-stage prostate cancer often shows no signs at all. 

Symptoms to look out for:

• Difficulty starting or stopping urination

• Weak or interrupted urine flow

• Frequent urination, especially at night

• Pain or burning during urination

• Blood in urine or semen

• Pain in the lower back, hips or pelvis

• Erectile dysfunction

What you can do:

• See a doctor if you experience any of these symptoms, especially if they are persistent or recurring. 

Myth 3: There’s no way to screen for prostate cancer

Fact: In Singapore, routine screening is recommended for men aged 50 and above or from age 45 for men who have a higher risk of developing the disease. Screening for prostate cancer consists of two parts - a digital rectal examination (DRE) and a blood test that measures Prostate-Specific Antigen (PSA) levels in the blood. During a DRE, a doctor performs a digital rectal examination to physically check the prostate for abnormalities. The blood test measures PSA, a protein produced by the prostate gland. Small amounts are normal but higher levels of PSA may indicate the presence of prostate cancer. 

What you can do:

• Talk to your GP about screening, especially if you are over 50 or have a family history of prostate cancer.

• Get tested: DRE and PSA testing are available at most GP clinics.

For low-risk or early-stage cases, active surveillance can be an effective way to manage your condition. (Credit: iStock.com/peakSTOCK)

Myth 4: If I have prostate cancer, I need treatment right away

Fact: Not all prostate cancers are aggressive, and some grow very slowly, and do not cause problems. For low-risk or early-stage cases, active surveillance through regular check-ups and testing can be a safe and effective way to monitor your health and avoid unnecessary treatment and side effects.

What you can do:

• Go for regular check-ups, and the necessary PSA tests, imaging and biopsies that your doctor advises to monitor and keep the disease in check. 

• Make informed treatment decisions with advice from your doctor and support from your family.

Myth 5: Surgery is the only way to treat prostate cancer

Fact: Surgery is not the only option to treat prostate cancer. Treatment depends on several factors including the patient’s age, overall health, PSA levels, DRE results, aggressiveness of the cancer and disease spread. Active surveillance and radiation therapy are other options that your doctor may discuss with you. 

Two types of radiation therapy are available to treat prostate cancer – conventional radiation therapy and proton therapy. Conventional radiotherapy delivers x-rays (also referred to as photons) to the tumour. Photons are electromagnetic waves that lose energy gradually while travelling inside the patient’s body, resulting in some radiation dose to tissues beyond the tumour. This may result in damage to nearby healthy tissues and cause side effects.

Conventional radiation therapy is an effective and safe treatment modality and remains the gold standard for treating most solid cancers. 

Proton therapy is one of the treatment options for prostate cancer, available at the NCCS Goh Cheng Liang Proton Therapy Centre.

Proton therapy is a more advanced form of treatment that targets the tumour more precisely, reducing radiation to nearby healthy tissues and organs, like the bladder and rectum. Patients who undergo proton therapy often experience fewer and less severe treatment-related side effects such as fatigue, urinary urgency or incontinence, bowel problems and erectile dysfunction which are commonly associated with prostate cancer treatment. It is also associated with a lower risk of developing radiation-related secondary cancers. Proton therapy is offered at the NCCS Goh Cheng Liang Proton Therapy Centre, the only proton therapy facility in Singapore’s public sector.

Patients must be reviewed by a multidisciplinary team comprising radiation oncologists, surgical oncologists and medical oncologists to evaluate and recommend the most appropriate type of treatment and post-care treatment plan based on their condition.

What you can do:

• Keep a record of your PSA levels and set reminders for follow-up check-ups.

• Attend your follow-up appointments to monitor and catch any signs of recurrence early.

• Ask your doctor to explain which types of radiation therapy may be suitable to treat your condition and find out about their comparative benefits, side effects and cost.

Prostate cancer is not always deadly, especially when it is diagnosed and treated early. Understanding the facts, going for regular screenings and check-ups, and having open discussions with doctors, family and friends can make all the difference. 

For more information on prostate cancer watch this two-part video series:

- SingHealth Answers All – Prostate Cancer (Part 1)

- SingHealth Answers All – Prostate Cancer (Part 2)

[1] Singapore Cancer Registry 2022 Annual Report.