Understanding Prostate Cancer

Prostate cancer is cancer that affects men that develops in the prostate, a small gland located below the bladder and in front of the rectum, which plays a role in producing fluid that forms part of semen.

Prostate cancer is the number one* common cancer among men in Singapore. In many cases, it grows slowly and may not cause significant symptoms for some time. Advances in screening, imaging and treatment have improved outcomes for prostate cancer, particularly when it is detected early.

At the National Cancer Centre Singapore (NCCS), patients with prostate cancer are cared for by multidisciplinary teams including urologists, medical oncologists, radiation oncologists, radiologists, pathologists and supportive care specialists. This page explains how prostate cancer is identified, treated and the support patients can expect throughout their care journey.

What Is Prostate Cancer

Prostate cancer develops when cells within the prostate gland undergo genetic changes that cause them to grow and divide in an uncontrolled manner. Over time, these abnormal cells can form a tumour that may remain confined to the prostate or spread to nearby tissues and distant parts of the body.

Most prostate cancers are adenocarcinomas, arising from the glandular cells of the prostate. Some tumours grow very slowly, while others may be more aggressive and require prompt treatment.

How Prostate Cancer Differs From Other Male Cancers

Prostate cancer has several features that distinguish it from other cancers :

• It often grows slowly and may not cause symptoms in its early stages 
• Some cases may not require immediate treatment 
• When the disease is advanced, it commonly spreads to bones These characteristics influence how prostate cancer is diagnosed, staged and treated 

Prostate Cancer Symptoms

Early-stage prostate cancer often causes no symptoms. When symptoms do occur, they may be related to changes in urinary function.

Common symptoms of prostate cancer include:

• Difficulty starting or stopping urination 
• Weak or interrupted urine flow 
• Frequent urination, especially at night 
• Pain or discomfort during urination 
• Blood in the urine or semen 
• Pain in the lower back, hips or pelvis in more advanced cases

These symptoms of prostate cancer are also common in non-cancerous prostate conditions, such as benign prostatic hyperplasia. However, any persistent or worsening symptoms should be assessed by a doctor.

Prostate Cancer Causes and Risk Factors

The exact causes of prostate cancer are not fully understood, but several factors are known to increase risk.

Non-modifiable Risk Factors

• Increasing age 
• Family history of prostate cancer 
• Certain inherited genetic mutations (e.g. BRCA 1 and BRCA 2)

Environmental and Lifestyle Factors

• Diets high in saturated fats 
• Obesity 
• Low levels of physical activity

Having risk factors does not mean that prostate cancer will develop, and many men diagnosed with prostate cancer have no identifiable risk factors.

How Prostate Cancer Is Diagnosed

Diagnosis focuses on determining whether prostate cancer is present and assessing how likely it is to grow or spread.

Prostate-Specific Antigen (PSA) Testing

A blood test measuring prostate-specific antigen (PSA) levels may be used as part of the assessment. Elevated PSA levels can be associated with prostate cancer but may also occur due to non-cancerous conditions. If higher than usual levels of PSA are found in a blood test that measures PSA levels, additional tests will be needed.

Clinical Examination

A digital rectal examination (DRE) allows doctors to assess the size, shape and texture of the prostate. If any abnormalities are found, you may be referred for further tests.

Imaging Tests

Imaging scans help to examine the prostate and guide further testing. These may include:

• MRI scans to identify suspicious areas within the prostate 
• CT or bone scans when there is concern about cancer spread

Biopsy and Pathology

A prostate biopsy is required to confirm prostate cancer. Tissue samples are examined by pathologists to determine the presence of cancer cells and how quickly it is likely to spread which helps to guide prostate cancer treatment.

Staging and Risk Classification

Staging and risk classification describe the extent and behaviour of prostate cancer and are central to treatment planning.

Assessing Disease Extent

Doctors assess:

• Whether cancer is confined to the prostate 
• Whether the cancer has spread to nearby tissues or lymph nodes 
• Any evidence of spread to the bones or other organs

Tumour grade and PSA levels are also used to estimate aggressiveness of the cancer.

Why Staging Matters

Staging and risk assessment helps to determine the extent of the disease and whether active surveillance or treatment such as surgery or radiation therapy is most appropriate. Patients are encouraged to discuss what their results mean for their individual situation with their treating doctor.

Treatment for Prostate Cancer

Treatment planning for prostate cancer at NCCS is individualised based on disease-related factors and the patient’s overall health.

Key considerations include:

• Stage and aggressiveness of the cancer 
• Patient’s age and general health 
• Potential treatment benefits and side effects

Active Surveillance

For some patients with low-risk prostate cancer, active surveillance may be recommended. This involves regular monitoring with PSA tests, imaging scans and biopsies. Treatment is started if there are signs of disease progression.

Surgery

Surgery to remove the prostate may be offered to patients with localised disease who are suitable to undergo an operation.

Radiation Therapy

Radiation therapy is a commonly used prostate cancer treatment and may be delivered externally or through internal techniques. It can be used as a primary treatment or after surgery in certain cases .

Proton Therapy

Proton therapy is a type of advanced radiation therapy that targets cancer cells using positively charged subatomic particles called protons. The unique physical properties of protons enable tumours to be more precisely targeted compared to the x-rays used in conventional radiotherapy. This minimises damage to nearby healthy tissues and organs and therefore results in fewer radiation-related side effects.

Click here to find out more about treatment at the Goh Cheng Liang Proton Therapy Centre at NCCS.

Hormone Therapy

Hormone therapy reduces levels of male hormones that can stimulate prostate cancer growth. It may be used alone or in combination with other prostate cancer therapy approaches.

Other Systemic Treatments

In selected cases, chemotherapy or newer systemic therapies may be considered, particularly for advanced or recurrent disease.

What Treatment Aims to Achieve

Treatment goals in prostate cancer vary depending on disease stage and individual cases and may include:

• Controlling or eliminating the cancer 
• Reducing the risk of disease progression or recurrence 
• Managing symptoms 
• Preserving urinary, sexual and overall quality of life

Care plans may change over time as the disease progresses.

Supportive Care and Living With Prostate Cancer

Supportive care is an important part of prostate cancer management and addresses both physical and emotional wellbeing of the patient.

Support may include:

• Management of symptoms that affect urinary or sexual funtion 
• Psychological and emotional support for patients and families 
• Rehabilitation 
• Guidance on lifestyle, diet and physical activity

Follow-Up and Monitoring

After prostate cancer treatment or during active surveillance, regular follow-up is essential.

Follow-up care may include:

• PSA testing at scheduled intervals 
• Clinical assessments 
• Imaging scans when clinically indicated

Ongoing monitoring allows early identification of any changes and enables timely intervention.

Guidance and Support at NCCS

Prostate cancer often requires long-term monitoring. At NCCS, patients are supported by multidisciplinary teams who provide clear information, coordinated care and support from diagnosis, to treatment and follow-up.

Patients are encouraged to participate in discussions about their care and seek clarification when needed.

For further information about prostate cancer care please visit www.nccs.com.sg.

Commonly Asked Questions 

1. Is prostate cancer common?

Yes. Prostate cancer is one of the most common cancers affecting men, particularly with increasing age.

2. Does prostate cancer always need treatment?

Not always. Some slow-growing cancers may be monitored with active surveillance.

3. What is a PSA test?

A PSA test measures prostate-specific antigen levels in the blood and may help to detect or monitor prostate conditions.

4. Can prostate cancer affect urinary or sexual function?

Yes. Both the disease and its treatments can affect urinary and sexual function. Support is available to help with these symptoms.

5. Can prostate cancer spread to other parts of the body?

Yes. Advanced prostate cancer may spread, most commonly to the bones.

*Singapore Cancer Registry Annual Report 2023