Treating prostate cancer
Prostate cancer is the second-most common cancer among men in Singapore, and its treatment depends on the stage of cancer or on the cancer’s aggressiveness, if it has spread beyond the prostate, and other factors. These are some of the prostate cancer treatment options that are available to patients.
Treating early-stage prostate cancer
In the early stages of prostate cancer, the cancer is limited to the prostate itself. In cases where the tumours are not causing any problems and are growing very slowly, or not growing at all, doctors may recommend that patients forgo aggressive treatment, and choose active surveillance to reduce potential side effects. Such patients simply have to return for regular check-ups to keep an eye on the tumours.
When prostate cancer treatment is necessary, patients face these two common options:
Both procedures, however, have significant and potentially life-altering side effects.
In Singapore and other technologically-advanced nations, the entire prostate is removed using a minimally invasive method using a da Vinci robot. The robot device provides three-dimensional vision, magnification and an articulating robotic wrist for higher precision than traditional open surgery. Since the nerves responsible for penile erections are located around the prostate and are easily damaged during this process, all men will experience some degree of erectile dysfunction after surgery. They will also experience urine leak and must also wear diapers. While most men recover from these side effects gradually over months or years, some may never fully recover.
Radiotherapy, which uses doses of radiation to kill prostate cancer cells, can have side effects that weaken the bladder and prostate, causing patients to feel the need to urinate frequently. They may also experience blood in urine or pain when they urinate.
Focal therapy for prostate cancer
In recent years, focal therapy has emerged as an alternative option to treat early-stage prostate cancer. Focal therapy refers to several minimally invasive methods that treat only tumour areas but spare the prostate’s healthy parts, resulting in a much lower risk of side effects.
High-intensity focused ultrasound (HIFU) therapy is a tried-and-tested focal therapy method. In this treatment, the doctor inserts a small ultrasound probe into the patient’s rectum and, guided by 3D images of the prostate, delivers a strong ultrasound beam aimed at the tumour to kill the cancer.
Similar to how a magnifying glass focuses rays of sunlight to burn a precise spot in a sheet of paper, the Focal One® HIFU probe focuses ultrasound waves on the tumour, rapidly increasing its temperature to destroy it while leaving the rest of the prostate’s healthy tissue intact. The beam’s focal point is just 1.7 millimetres in diameter, giving physicians exceptional control over the process.
Patients have no scars because there is no incision and no cutting. They will also experience a much smaller risk of erectile dysfunction and urinary incontinence. A 2018 study in the United Kingdom found that only two out every 100 patients who undergo HIFU therapy use diapers due to urine leak. As the procedure takes between 30 minutes and two hours, some patients can return home on the same day.
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Fighting late-stage prostate cancer
For men with late-stage prostate cancer, where the cancer has spread to other parts of the body, doctors usually advise hormone therapy as a first step. Most prostate cancer cells rely on testosterone to grow, so hormone therapy medication limits its production. This therapy alone does not cure prostate cancer. Other prostate cancer treatment, such as chemotherapy or immunotherapy, may also be used.
This article has been verified medically by Dr Chong Kian Tai, consultant urologist of Surgi-TEN Specialists at Farrer Park Hospital (Singapore).