When Raymond Lim was diagnosed with prostate cancer in October 2023, his immediate reaction was shock. He didn’t have any symptoms and only got diagnosed as a result of losing his wife to pancreatic cancer.
"He told me I could do a blood test and there was a promotion going on, three tests – pancreatic, lung and prostate cancer – for the price of one."
The test results revealed slightly elevated prostate-specific antigen (PSA) levels and he was referred to a public health institution for close monitoring. After repeated tests, his urologist wasn’t comfortable with the trend and Raymond eventually did a biopsy. This was when he was diagnosed with stage 3 prostate cancer, with 20% of his prostate gland infected.
Even though this diagnosis came as a surprise, he knew that it wasn’t a death sentence and that prostate cancer is treatable if diagnosed early. This is something the experts agree on and the statistics show too.
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Clinical Assistant Professor Johan Chan, Consultant, Division of Medical Oncology, National Cancer Centre Singapore (NCCS), cites the Singapore Cancer Registry 2022, which lists prostate cancer as the most common cancer affecting men in Singapore between 2018 and 2022. It accounted for about one in six cancer diagnoses, with over 7,500 cases reported.
Clinical Assistant Professor Raj Vikesh Tiwari, Consultant, Department of Urology, Sengkang General Hospital (SKH), reveals that, despite its high incidence, prostate cancer ranks fifth in mortality, accounting for 7% of all male deaths.
Getting a prostate cancer diagnosis
Because it’s highly treatable when diagnosed at an early stage, it’s crucial for men to be aware of the symptoms of prostate cancer. Dr Chan notes that it often presents without symptoms in its early stages, with many men discovering the disease during routine medical check-ups or blood tests.
However, he lists possible early symptoms:
- difficulty passing urine.
- increased urinary frequency – particularly at night – and a weak or interrupted urinary stream.
- Some men may also experience burning or pain during urination or notice blood in the urine or blood in semen.
"As the disease progresses, systemic symptoms such as unexplained weight loss, loss of appetite and pain in the back, hips, chest (ribs) or other bones may occur, indicating that the cancer may have spread."
Once you have spoken to your doctor about your symptoms, there are several options he might take to determine if it’s prostate cancer.
Dr Tiwari says suspicion of prostate cancer arises from an elevated prostate-specific cancer antigen (PSA) blood test or an abnormal digital rectal examination. This is followed by an MRI scan of the prostate to detect tumours in the prostate and a biopsy of the prostate to confirm the diagnosis.
Dr Chan says that the life expectancy of someone with prostate cancer depends on the stage at which the cancer is diagnosed. The Singapore Cancer Registry reported that the five-year survival rate for prostate cancer between 2018 and 2022 was close to 90%.
"In contrast, late-stage prostate cancer, where the cancer has spread to other parts of the body, has a much lower five-year relative survival rate of 36.6%."
Dr Tiwari adds that at stage 4, when the cancer has metastasised or spread to other parts of the body, it becomes incurable and the life expectancy may be reduced to five to seven years with treatment. And, in the most advanced stage of prostate cancer, life expectancy reduces to around 13 months due to the aggressive nature of the disease and its resistance to conventional treatments.
Risk factors and treatments
There are certain factors that increase a man’s risk of developing prostate cancer. Dr Chan lists them:
- Age – This is the strongest risk factor. Men above the age of 50 are at risk and the risk increases with age.
- Ethnicity – In Singapore, Chinese men have double the risk of getting prostate cancer compared to Malay or Indian men.
- Diet – The exact role of diet in prostate cancer is not clear. Men who consume a lot of dairy products may have a slightly higher chance of getting prostate cancer.
- Family history – Men are two-and-a-half times more likely to develop prostate cancer if their father or brother has been diagnosed, compared to those without affected relatives. The risk of hereditary prostate cancer is also higher in men with family members diagnosed with other cancers.
A multidisciplinary team of specialists assesses each patient to determine the most suitable treatment approach, which may involve a combination of therapies.
For early-stage prostate cancer, treatment options include active surveillance, surgery, radiotherapy and hormonal therapy. In advanced stages, where the cancer has spread to other parts of the body, more intensive treatments are required.
"The choice of treatment depends on individual circumstances, with a personalised approach aimed at balancing effectiveness with minimising side effects."
Dr Tiwari reveals that recent advancements in treatments for castrate-resistant prostate cancer include genetic-related treatments and prostate cancer membrane antigen (PSMA) PET scan treatments, which have shown promising results.
A positive attitude to prostate cancer
Poh Heng, 69, was diagnosed with stage 4 prostate cancer in mid-2023. He experienced difficulty urinating and blood-stained urine, prompting a visit to the polyclinic. There, he underwent a urine test and was referred to SKH for further evaluation, including urine and blood tests, a bone scan and MRI.
The tests revealed his cancer had spread to his bones and spine and he is currently receiving hormonal therapy. Despite his diagnosis, he makes time to cycle, swim, jog or hike three to four times a week.
Raymond believes that his strong faith and positive outlook have helped him deal with his cancer diagnosis and treatment. While it is important to get the necessary medical interventions, the appropriate nutrition, regular exercise and good sleep, the mindset is crucial too.
"Being Christian helps me in prayer and going to church but if you're not, then do other things that have a positive effect on your mental health. You should also have support from close friends, to bring you out and get your mind off things. For example, instead of walking alone, walk with a group."
Images courtesy of Raymond Lim.
Raymond is currently clear of cancer but has to go for frequent check-ups for five years. He is more careful with his food choices and exercises regularly.
He says it’s important to “recognise that you have a new lease of life, so make use of it”. He encourages men to get tested for PSA as it is a simple blood test.
Poh Heng advises men over 55 years old to seek medical attention for urinary issues and frequent nighttime urination.
He also emphasises the importance of maintaining a positive mindset: “If diagnosed with cancer, don’t see yourself as just a patient; instead, focus on living life fully and cherish each extra day as a win”.
