Prostate Cancer

In 2017, Hong Kong Cancer Registry (HKCaR) from Hospital Authority released Hong Kong Cancer Statistic of 2016 stated that prostate cancer ranked 4th in total incidence rate and 1,912 new cases registered every year; ranked 7th in total mortality and 410 cases every year. Yet, Prostate cancer ranked 3rd in incidence and 5th in mortality rate among most common cancers in Hong Kong male.

The exact causes of prostate cancer are still unknown, but it is believed that several factors could increase the likelihood of developing the disease e.g.

  • Male
  • Age 50 or above
  • First degree relatives (including father, brother, and son) who have, or have had prostate cancer
  • High fat diet
  • Being obesity
  • Long-term exposed to heavy metal (e.g. Cadmium)

Since most of the prostate cancer is asymptomatic at the early stage, and their symptoms are similar to that of prostate hyperplasia, therefore, it is usually being neglected.

 

Advanced prostate cancer may cause symptoms including:

  • Weak and interrupted flow during urination
  • Pain in urination
  • Difficulty during urination and unable to empty the bladder completely
  • Blood in the urine
  • Frequent pain in lower back, hips and upper thighs

 

Please consult your doctor if you have any of these symptoms.

  • Digital Rectal Examination (DRE): This is a preliminary test for prostate cancer. In DRE, medical professional inserts a gloved and lubricated finger into rectum and assesses if any abnormality in prostate through anterior rectal wall.
  • Prostatic Specific Antigen (PSA) Test: The PSA test is used to measure the level of PSA in blood. When the PSA level is higher than normal, it may represent prostate cancer or benign prostate hyperplasia. Patient who have high PSA level should receive additional tests.

Prostate Health Index (PHI) Test: PHI combining measures Total Prostate Specific Antigen (PSA), Free PSA and PSA Precursor to calculate the possibility of prostate cancer. Higher the value of PHI, higher the likelihood of having prostate cancer. This test is mainly for patients whose PSA test value are moderate (4-10 ng/ml), and as an aid to decrease the false positive rate from PSA test.

  • Transrectal Ultrasound Scan (TRUS) and Biopsy: Doctors could assess the size of prostate and development of tumor by passing ultrasound probe into the rectum. During the test, doctors can use THUS to guide a needle to collect some sample of prostate tissue and check whether signs of cancer exists under microscope. Patients may feel uncomfortable during the test, but it should only take a few minutes.

Stage I: Usually asymptomatic and not detected by digital rectal examination. The tumor is found in the prostate only.

Stage II: Usually asymptomatic, but could be detected by digital rectal examination or ultrasound scan. Tumor is still only located within the prostate.

Stage III: Might present difficulty or pain during urination. The cancer cells has spread from prostate to nearby tissues such as seminal vesicle and lymph nodes.

Stage IV: The cancer cells has spread to distant lymph nodes, bones or other organs.

Many treatment options are available for prostate cancer. Doctors will recommend the most suitable treatment plan based on the stage and grade of cancer, patient’s age, lifestyle, general health condition and his/her preference.

 

Active Surveillance

Prostate cancer often grows very slow, and the side effects from treating the prostate cancer may be more distress than having the cancer itself. Therefore, if the cancer cells only invade to a very small part of the prostate, and it does not cause a major impact to patient’s daily life, “Active Surveillance” would be recommended to patients in advanced age or patients who had been diagnosed other serious diseases.

 

Active surveillance is monitoring the prostate cancer closely and require patient to have PSA test and digital rectal examination every 3 to 6 months. If symptoms present or the cancer cells grow rapidly, doctors may consider to change the treatment plan when necessary.

 

Surgery

Radical Prostatectomy

In this operation, the whole prostate gland and the surrounding tissues would be removed through open prostatectomy or minimally invasive (including robot-assisted laparoscopic prostatectomy). The goal of this operation is to cure the prostate cancer. It is suitable for localized prostate cancer and patient who have good physical condition. Patient will be under general anesthesia or para-anesthesia with sedation during operation.

Urethral Resection of the Prostate (TURP)

Under guided by resectoscope, an instrument with a small loop of wire at the end passes through urethra. The heated wire of this instrument remove a section of prostate which placed pressure to urethra. The goal of TURP is to relief patient troublesome symptoms, e.g. difficulty during urination, rather than to cure the prostate cancer. TURP is suitable for late-stage patient or patient who have contraindication for radical prostatectomy. Patient will be under general or spinal anesthesia during operation.

Hormonal Therapy

The growth rate of prostate cancer cells is correlated to the level of male hormone, testosterones and androgens. Hormonal therapy works by reducing the production of testosterones and androgens in body and thus slowing down the tumor growth rate, relieving symptoms or reducing the tumor size by surgery or medication. However, prostate cancer could not be cured completely by hormonal therapy.

Radiotherapy

Radiotherapy is a treatment which using high-energy radiation beam to destroy prostate cancer cells, or to shrink the tumor, meanwhile, avoid damaging normal cells. It can cure prostate cancer and also relief pain associated with it, especially the pain from bones.

Chemotherapy

Chemotherapy is a treatment which using drugs to destroy cancer cells. The drugs go through every parts of the body via the bloodstream. It kills the prostate cancer cells by interrupting the growth and division of the cancer cells. However, normal cells are also being destroyed by the drugs because it could not differentiate between cancer cells and normal cells.

Although there is no sure way to prevent prostate cancer, it is recommended male should:

  • Have prostate screening routinely start from age of 50
  • Maintain healthy lifestyle
  • Perform physical exercise regularly
  • Have low fat diet