Men's Clinic in Singapore (Caring & Treating Since 2005)
Prostate Cancer Screening
If detected and treated early, more than 90% of prostate cancer can be considered curable
Prostate cancer is the second most frequently diagnosed cancer in men, and the sixth leading cause of cancer deaths in men worldwide.
Many types of prostate cancers are slow growing, and may not cause any symptoms for a long time; however, some types can be more aggressive and grow rapidly.
Prostate cancer can spread - or metastasize - commonly to the bone, lymph nodes, colon and bladder.
Once it has spread, it is much more difficult to treat. This is where screening becomes important - screening for cancer means looking for and detecting cancer before there are any symptoms.
If detected and treated early, more than 90% of prostate cancer can be considered curable.
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What is Prostate Cancer Screening?
Prostate cancer screening is a blood test called PSA
The first step in prostate cancer screening is a blood test called PSA, or prostate-specific antigen.
This is a protein that is secreted from the cells of the prostate gland. It is present in normal amounts when there is no prostate disease, but will usually be elevated in prostate cancer; it can also sometimes be raised in other conditions including benign prostatic hyperplasia (BPH) and prostatitis.
Prostate Cancer Screening can help identify cancer earlier when treatment is most effective. However, PSA screening is not routinely recommended for everybody and different organizations will vary on their guidelines; this is because not all types of prostate cancer may require treatment depending on your age and other comorbidities, and testing may result in unnecessary anxiety and stress.
Prostate Cancer Screening Services
1.) PSA Testing
Most guidelines will encourage PSA testing for men between the ages of 50-70 years old, but screening can be done in younger men with certain risk factors as well. Apart from age, other factors that may increase the risk for prostate cancer include:
- Family history of prostate cancer
- African ethnicity
- Infection (especially STI’s such as chlamydia, gonorrhea, and syphilis)
- Lack of exercise and a sedentary lifestyle
- Exposure to certain toxins and herbicides (e.g. Agent Orange)
2.) Free PSA Testing
Another related test that you may have heard about is the level of “free PSA” in the blood.
Normally, PSA is found in the blood either “bound” to a circulating protein or “free” or unbound. The normal PSA test done measures your total PSA (both bound and free).
Because PSA levels can be elevated in other conditions apart from prostate cancer, such as BPH or prostatitis, one way of determining who is high risk for cancer and may warrant a biopsy is by measuring the free PSA level.
Studies have shown that men with greater than 25% free PSA are more likely to have a benign condition, and men with less than 10% free PSA are more likely to have prostate cancer. This free PSA level can help to save a patient from more expensive scans or invasive procedures like a biopsy.
What will happen when I see the doctor?
We will start with a consultation to determine if you have any symptoms or risk factors for prostate cancer. This discussion will include questions on your past medical history, medications, and family history.
We will then perform a physical examination, which would include a digital rectal exam (DRE) - this is to gauge the approximate size and texture of the prostate gland, and to look for any suspicious masses arising from the gland. We will then take a blood sample for the PSA level.
You will be contacted by your doctor a few days later with the results, and a follow up appointment may be advised if necessary.
What happens if my PSA level is high?
Are there any Follow up
Depending on the level of PSA and your risk factors, you may be advised to either monitor for symptoms and repeat the PSA test in a few months (if low risk), or proceed for further assessments (if high risk).
As discussed above, we may also recommend running a free PSA level to be more precise about our risk assessment. Close monitoring is termed Active Surveillance or Watchful Waiting, and repeat PSA testing over a period of time can help doctors look for the rate of increase of PSA levels, known as PSA Velocity.
If deemed high risk, you would be referred for further testing, which may include scans such as a transrectal ultrasound or a magnetic resonance imaging (MRI), and subsequently a prostate biopsy, which involves an ultrasound-guided sampling of prostate tissues for pathological evaluation.
The tissue sample can provide a diagnosis of prostate cancer and also the grading of cancer, using a system called the Combined Gleason Score (GCS).
What is the PSA Velocity?
The PSA Velocity is the rate at which your PSA levels change over time.
These can be monitored by a doctor to determine when it may be necessary to evaluate further with scans or a biopsy.
Higher rates of PSA increase (> 2.0 ng/ml per year) may be associated with potential prostate cancer, enlargement, or infections.
What are the symptoms of prostate cancer?
Symptoms are not always present in prostate cancer, and conversely, the presence of symptoms does not always mean that it exists.
However, one or more of the following symptoms (especially if someone has other risk factors for prostate cancer), should prompt a visit to the doctor:
- Frequent urination (especially at night)
- Hesitancy and difficulty to start urination
- Dribbling and difficulty to stop urination
- Weak or interrupted urine flow
- Blood in the urine or Blood in semen
- Difficulty obtaining or maintaining an erection
- Painful ejaculation
- Bone pain from metastatic disease (usually in the thigh bones, pelvis, or lower back)
What treatment is there for prostate cancer?
Fortunately, there are many effective options for prostate cancer now available, especially when detected and treated early, with 5-year survival rates now more than 90%!
Depending on the grade and stage of disease, your doctor will advise on the most appropriate treatments. These may include hormonal chemotherapy, radiation therapy, or surgery (including robotic microsurgery).
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If you are experiencing any symptoms, or have any concerns or questions about prostate cancer and prostate cancer screening, please make an appointment with our clinics today or visit any of our Men's Health Clinics or drop us an email at email@example.com for an appointment.