Prostate cancer is the cancer of the prostate gland. The prostate is a walnut-sized gland in between the bladder and the urethra that nourishes and transports sperm. Prostate cancer is the third most common cancer among men in Singapore.
Early stage of prostate cancer has few or no symptoms as the cancer develops slowly. If symptoms appear, they may include difficulty in passing urine, burning sensation while urinating, blood in urine, loss of appetite and/or weight, and lower back pain.
Prostate cancer is diagnosed through a biopsy. At Urohealth Medical Clinic, we offer MRI Targeted Biopsy of the prostate. Dr Tan Yung Khan, Medical Director and Senior Consultant Urologist of Urohealth Medical Clinic, was the first in Asia to perform the MRI Targeted Fusion Biopsies of the prostate using the UroNav Platform. Using MRI and fusion with ultrasound, targeted biopsies of the prostate are performed. This improves the accuracy of the biopsies and reduces the need for repeat biopsies. However, biopsies are not performed on all men. A biopsy is suggested following some indications such as an elevated PSA (Prostate Specific Antigen), a significant change between consecutive PSA tests and an abnormal rectal examination.
Magnetic Resonance Imaging (MRI) Targeted Biopsy of the Prostate (UroNav Biopsy)
Elevated levels of PSA can be associated with a number of reasons. These include infection, prostatic enlargement but most concerning of them all, prostate cancer.
In the past, to exclude prostate cancer in patients with raised PSA, the patient would be subjected to a systematic or random biopsy of the prostate. This involves 12 biopsies taken from the prostate in a random manner. As such, it is likely possible to miss a cancer and in the event that the biopsy was negative for cancer, the patient would have to undergo another random biopsy if the PSA was still elevated.
In the recent few years, we have discovered that MRI of the prostate can offer valuable insights as to whether an elevated PSA is due to cancer. As such, using MRI and fusion with ultrasound, we can now do targeted biopsies of the prostate. This allows for a quantum leap in accuracy of the biopsies and reduces the need to repeat them. This lowers the risk of infection with repeated biopsies. Targeted biopsy of the prostate can be carried out under sedation or local anaesthesia and patients usually can be discharged on the same day.
Why do it with us?
Dr Tan Yung Khan was the first in Asia to perform MRI targeted fusion biopsies of the prostate using the UroNav platform. In his published series, he has shown that in his hands, there has been a significant improvement in the detection of clinically significant prostate cancer. Dr Tan Yung Khan has also gone on to set up the Asia Pacific Centre of Excellence for UroNav guided targeted biopsies and has given talks and run masterclasses for urologists in the region on the use of this system.
Treatment will depend on the type of cancer. Treatments include Radiation (using high-dose x-rays or other particles to kill cancer cells), Hormonal therapy (using hormones to slow or stop cancer growth), Chemotherapy (using drugs to destroy cancer cells) and Surgery to remove the cancer. (Robotic Radical Prostatectomy/Laparoscopic Radical Prostatectomy.
Surgery involves removing the prostate completely.
- ROBOTIC RADICAL PROSTATECTOMY
World reknowned Da Vinci Surgical System is the robotic system that surgeons use to robotically remove the prostate. It is less traumatic and minimally invasive. The Da Vinci Robotic Prostatectomy improves the surgeon’s visualisation, dexterity and precision compared with open or laparoscopic surgery while enabling operation through 1-2cm incisions.
- LAPAROSCOPIC PROSTATECTOMY
This is a minimally invasive surgery procedure to remove cancerous prostate. The surgeon makes a few small incisions compared to one large incision in open surgery leading to less abdominal trauma and a faster recovery process.
Prostatitis is the swelling and inflammation of the prostate gland. The prostate is a walnut-sized gland in between the bladder and the urethra that nourishes and transports sperm.
Symptoms of prostatitis include painful, difficult and/or frequent urination, pain the groin or pelvic area, blood in urine, body aches, pains and fever.
Prostatitis is diagnosed by an examination of the prostate gland and a urine test.
Treatment will depend on the underlying cause of prostatitis. Treatments include Medication which is usually antibiotics and/or anti-inflammatory medications.
Benign Prostate Hyperplasia (BPH)/Prostate Enlargement
Benign prostate hyperplasia is the benign enlargement of the prostate gland. This is a common condition among older men. As many as 50% of men at 50 years of age will have it and up to 80% at 80 years of age. The main function of the prostate is related to the production of fluids that accompany semen during ejaculation. The prostate lies between the bladder and the penis. As such, when it grows bigger it can lead to obstruction of the flow of urine during urination. Long term obstruction can lead to urinary tract infection.
Symptoms of prostate enlargement include slow urination, starting and stopping of urine flow and frequency of urination.
Prostate enlargement is diagnosed by a rectal examination, a urine test, uroflow test, and PSA (Prostate Specific Antigen) test.
Treatments for prostate enlargement include Medication and Surgery. Some drugs known as alpha blockers can help relax the prostate to improve flow. Drugs like 5 Alpha reductase inhibitors can go some way in shrinking the prostate. Both kinds of drugs can reduce symptoms by about 30% but have some side effects and need to be taken in the long term otherwise symptoms may return.
Surgical methods can also be employed to manage an enlarged prostate.
- TRANSURETHRAL RESECTION OF THE PROSTATE
This procedure involves scraping the prostate to create a channel for the flow of urine. It is the mainstay of treatment for BPH and is effective in relieving prostatic obstruction. However, this procedure may be associated with urinary incontinence, bleeding and retrograde ejaculation.
- GREENLIGHT LASER VAPORISATION OF THE PROSTATE
This laser reduces complication rates and shortens hospital stays. Surgical methods have shown to have long lasting improvement to urinary symptoms and flow. Furthermore, the improvements offered by these surgeries are in the range of 80% compared to the 30% of drugs.
- TRANSURETHRAL RESECTION OF THE PROSTATE
- UROLIFT SYSTEM TREATMENT
Not all patients are comfortable with long-term medications or surgery. Fortunately today, we have the UROLIFT SYSTEM TREATMENT. This treatment for enlarged prostates is FDA approved, minimally invasive and bridges the space between medications and more invasive surgeries. This procedure lifts the enlarged prostate and holds the tissues in place using small Urolift implants thereby unblocking the urethra. It does not require cutting, heating or any removal of the prostate. It is usually done under local anaesthesia in a clinic setting or day surgery centre. A catheter will not be required after the procedure and patients can typically return home the same day.
The PSA blood test is regularly offered as part of health screenings. PSA stands for Prostate Specific Antigen and as its name suggests, it comes from the prostate. PSA is protein made by both normal prostate cells and also cancer cells of the prostate. It is not made by other body tissues which is why it is “prostate specific”. The function of the prostate is to help make semen more liquid so that the sperm can swim freely. Usually, the PSA is secreted together with semen but abit of PSA can leak back into the blood stream and this is then deteced on the PSA blood test.
PSA was first used in 1986 to monitor patients who already had prostate cancer. A rising level usally indicated that there was progression of the disease whereas a dropping level indicated effectiveness of treatment. In 1994, PSA was approved as a screening test for prostate cancer. Unforuntately, because PSA is also produced by non-cancer cells, it is not very specific for cancer. Nowadays in Singapore, we often use a level of 4.0ng/mL as a cut off for suspicion of cancer where PSA levels of more than 4.0ng/mL are more likely to harbor cancer. This is a rather artificial level as large population studies have found that up to 15% of men with PSA of 4.0ng/mL or less may have cancer of which 15% of those cancers required treatment. As such, patients with a PSA of 4-10ng/mL probably have a 15-25% chance of harboring cancer and a 75% chance that the raised PSA is related to a non-cancerous cause.
Raised PSA levels in the blood can occur in a few situations. This can include situations of enlarged prostate, infections of the prostate or prostate cancer.
Symptoms of raised PSA include urination issues such as poor urine flow or dribbling of urine, straining while urinating, blood in urine or recurrent urinary tract infections with painful urination.
In the setting of a likely infection, antibiotics can be taken to reduce raised PSA.
With suspicion of cancer, further evaluation with multiparametric MRI of the prostate and a more sensitive blood test known as the PHI (Prostate Health Index) test can help determine the likelihood of clinically significant prostate cancer.
The PHI test known as the Prostate Health Index is a formula that combines all 3 PSA forms (total PSA, free PSA, and p2PSA) into a single score. Low PHI scores are associated with a lower probability of prostate cancer and higher PHI scores are associated with an increased probability of prostate cancer.