Prostate Cancer

– The information has been reviewed by Dr. Wong Ming Ho, Edmond

Epidemiology

Prostate cancer is the third most common cancer in men in Hong Kong. In 2018, 468 males died from prostate cancer, accounting for 5.5% of cancer deaths in males. There were also 2,204 newly diagnosed cases.

What is Prostate Cancer?

A part of the male reproductive system, the prostate is a gland that produces a thick fluid that forms part of semen. Prostate cancer occurs when there is an abnormal growth of cells in the prostate gland, and is often seen in patients over the age of 50. As prostate enlargement is quite common in older men, combined with the fact that many prostate cancers grow slowly, it may be difficult to detect prostate cancer early. As a result, many patients do not get diagnosed until the cancer is already at an intermediate or advanced stage.

Symptoms

Frequent urination
Difficulty urinating
Pain during urination
Blood in the urine or semen
Pain in the pelvis or spine
Swelling in the legs or feet

Causes + Risk Factors

The causes of prostate cancer remain unclear, but risk factors include age, smoking, and diets heavily comprised of processed foods.

Risk Factors

Age: prostate cancer is most common in men over the age of 50
Family history: risk increases if a blood relative has been diagnosed with prostate cancer

Diagnosis

To increase the survival rate of prostate cancer, medical practitioners recommend that males over the age of 55 be regularly screened for prostate cancer, even in the absence of symptoms. For those who suspect they may have prostate cancer, or are experiencing symptoms, a specialist may recommend an ultrasound or MRI.

Prostate cancer screening: the doctor will determine risk of prostate cancer by assessing symptoms, and by conducting a digital rectal exam, urine flow test, and kidney function test.
Blood test: if the patient has an enlarged prostate, infection of the prostate gland, or prostate cancer, his prostate-specific antigen (PSA) level will be significantly higher.
Ultrasound: this test may involve two components: a transrectal ultrasound where a small probe is inserted into the rectum to obtain a clearer picture of the prostate gland; and a biopsy where samples of the prostate are retrieved for further examination under a microscope. The latter is often performed if the PSA level is found to be high.
MRI: MRI may be used alongside transrectal ultrasound to better guide the biopsy and improve the accuracy of diagnosis.

Treatment

Treatment options for prostate cancer depend on the stage and progression of the cancer. Treatment for early-stage prostate cancer may include active surveillance, surgery, or radiation therapy.

Active Surveillance	As prostate cancer grows slowly during the early stages, it may not affect the longevity of a patient, especially if he is older. The doctor may recommend active surveillance instead of specific treatment.
Radiation Therapy	Radiation therapy uses high-energy rays to kill cancer cells.
Surgery	To control the disease over the long term, the doctor may opt to remove the entire prostate gland through robotic prostatectomy. In this procedure, the surgeon uses surgical instruments attached to a robotic system to accurately operate through several small incisions, with the help of high-resolution, 3D images. Compared to traditional surgery, this approach involves less pain, less blood loss, and quicker recovery for the patient.
Hormone Therapy	If the cancer has spread into the bones or other major organs, the doctor may suggest hormone therapy to stop the production of male hormones. Treatment options include surgery to remove the testicles or medications that control the production or activity of male hormones.

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