Prostate Cancer

Prostate cancer is the third most common cancer in males in Malaysia. Early prostate cancers are usually asymptomatic. Therefore, prostate cancer is known as a silent killer.

Prostate cancer develops in the prostate, which is a small walnut-shaped gland that is a part of the male reproductive system. It is more likely to affect older man and is most common at 50 years of age and above. Hence, all men aged 50 and above are encouraged to go for prostate cancer screening by a urologist.

There are several types of prostate cancers:

• Adenocarcinomas: The most common type of prostate cancer. There are 2 types of adenocarcinomas which are acinar adenocarcinoma (develops in gland cells that line the prostate gland) and ductal adenocarcinoma (develops in the cells that line the ducts or tubes of the prostate gland)
• Small cell carcinomas: A type of neuroendocrine carcinoma
• Transitional cell carcinomas: Begins in the cells that line the tube of the urethra
• Squamous cell carcinoma: Begins in flat cells that cover the prostate
• Other rare cancers: Sarcoma, lymphoma

Men with early prostate cancer usually do not experience any symptoms. Those in more advanced stages of prostate cancer may experience symptoms such as:

• Difficulty in passing urine
• Urinary hesitancy (weak urine flow, difficult to maintain a stream)
• Frequent urination
• Blood in the urine
• Blood in the semen
• Painful ejaculation
• Erectile dysfunction
• Bone pain

The Gleason score or Grade Group is the most common system used by doctors to grade or stage prostate cancer. Prostate cancer cells are graded from 3 to 5 based on the rate of spreading and the aggressiveness of the disease. The two most common Gleason grades are added together to produce an overall Gleason score.

There are 5 Grade Groups with Group 1 being the least aggressive (slow-growing cancer) and Grade 5 being the most aggressive (fast-growing cancer).

Prostate cancer screening is an effective way to detect prostate cancer in its early stages. Most prostate cancer screenings start at 55 years of age.

Tests to diagnose prostate cancer include:

• Digital rectal exam: Your doctor will examine the prostate to find any abnormalities in the shape or size of the gland.
• Prostate-specific antigen (PSA) test: PSA is produced by the prostate gland. A blood sample is taken to check for PSA levels that are higher than normal.
• Biopsy: A tissue sample from the prostate is taken using a thin needle to be analysed for cancer cells.
• Imaging tests: An image of the prostate gland is taken by using ultrasound or magnetic resonance imaging (MRI) scans.

Learn more about the different types of screening and diagnostic procedures performed to diagnose prostate cancer.

Treatment for prostate cancer depends on several factors such as the rate of grow and spreading of cancer, overall health, and personal preferences. In most cases, prostate cancer is very treatable.

Patients diagnosed with prostate cancer may be treated with:

1. Surgery

Radical prostatectomy is a surgical procedure to remove the prostate either robotically, laparoscopically or using the conventional open surgery method.

2. Radiotherapy

External beam radiation therapy delivers strong X-ray beams directly to the tumour from the outside of the body.

Brachytherapy delivers radiation internally by placing radioactive seeds within the prostate to destroy the cancer cells and preserve surrounding healthy tissue.

3. Hormonal therapy

Hormonal therapy stops the body from producing testosterone by blocking the production of testosterone to prevent prostate cancer cells from growing.

Hormone medications include luteinizing hormone-releasing hormone (LHRH) and gonadotropin-releasing hormone (GnRH) agonists and antagonists prevent the body from producing testosterone.

4. Chemotherapy

Chemotherapy uses drugs to destroy cancer cells that is administered intravenously, orally (as a pill) or both. This may be a treatment option for prostate cancer that has spread to other parts of the body.

Complete prevention of prostate cancer is not possible. However, there are some ways to reduce the risk of prostate cancer:

• Regular prostate cancer screening tests
• Quit smoking
• Maintain a healthy weight and exercise regularly
• Eat a healthy diet

Prostate cancer is highly treatable, and early detection is essential for better outcomes. Prostate cancer can be detected early through PSA tests and a digital rectal exam, but it should be noted that both tests may not be 100% accurate as many factors can affect the results. Thus, it is recommended that men at average or high risk should discuss with their doctors to consider prostate cancer screening.

Discuss with your doctor to understand if you would benefit from screening for prostate cancer.