Why Should You Take a Prostate Exam?

If caught early, treatment outcomes for prostate cancer are promising.

The 5-year survival rate is more than 95%. Even in advanced cases, if the cancer hasn't spread, the survival rate is more than 80%.

"What might be surprising is that 30% of patients with very advanced prostate cancer can expect to survive for at least 5 years," says Dr Michael Wong, urologist.

In fact, in cases where the mass is small and is contained within the prostate itself, most doctors simply monitor their patients rather than recommend more aggressive forms of treatment. To find out more about your condition and treatment options, speak to a specialist.

Here are the facts you need to know about prostate cancer, and what to expect when you get tested for it.

Can prostate cancer be detected early?

Screening for prostate cancer can help to detect the cancer before symptoms develop or when the growth is still in its early stage. As prostate cancer can sometimes spread unnoticed, early detection often makes the cancer easier to treat, allowing a more positive prognosis.

Am I at risk of prostate cancer?

Like other cancers, your chances of developing prostate cancer are dependent on various factors, including your age, race and family history.

Age: The older you are, the higher the risk of developing the disease.

Race: Asian-Americans and Latino-Americans have a lower risk of developing prostate cancer, as compared to Caucasians. African-Americans have the highest risk.

Family history: If your father, brother or uncle has ever been diagnosed with prostate cancer, your chances of developing the disease are higher.

When should I get a prostate cancer test?

Visit your doctor for a prostate cancer test if you have the following symptoms:

• Difficulty passing urine
• Passing urine more often during the night
• Blood in your semen
• Problems getting or keeping an erection

A urologist will investigate whether you just have an enlarged prostate, which is usually a natural part of ageing, or if there are any cancerous cells.

If you have no symptoms, Dr Wong still advises going for screening on a regular basis after the age of 45, especially if your race or family history puts you at risk.

If you know of family members who have the BRCA1 and BRCA2 genes (commonly associated with an increased risk of breast and ovarian cancer), then you should also go for screening. The link between these genes and prostate cancer is currently being investigated, although the results are not yet finalised.

If you're not sure about your family history, check with your doctor to see whether you need a test.

Types of prostate cancer tests

There are several different tests your doctor may recommend to check your prostate:

Digital rectal exam: Your doctor will examine your rectum to feel for any unusual lumps in the prostate area.

Ultrasound: Your doctor may insert a small probe into your rectum to take pictures of the prostate.

Prostate-specific antigen (PSA) test: This blood test is the most commonly used method to check for an enlarged prostate, prostatitis (swelling) and prostate cancer. However, this test alone is not reliable to check for cancer. Combining it with PHI (Prostate Health Index) blood tests and 4Kscore biopsy tests is thought to be more accurate.

Biopsy: If your PSA results are high, your urologist will perform a biopsy to have the tissue from the prostate checked for cancer cells. Many men are concerned about this procedure, but in reality, it's a simple, 10-minute procedure.

What to expect

Here's what you can expect during a biopsy: your urologist will insert a needle through the wall of your rectum and into the prostate to remove small pieces of tissue for testing. A dozen or so samples from various areas of the prostate will be taken.

This procedure causes only mild discomfort, but you may experience a little blood in your urine and semen, and some light bleeding from your bottom, which can last for several weeks.

Sometimes, biopsies may miss the cancerous part of the prostate, and your urologist may need a repeat procedure to test more areas.

In some cases, your urologist may use an MRI ultrasound fusion prostate biopsy to increase the accuracy of detecting small prostate cancer lesions that are not clinically palpable using other techniques.

How long will it take to get my biopsy results?

The samples will be sent to a lab to be analysed and your urologist will get the results back within a few days. If the test detects cancer, you will receive a Gleason score. This scale indicates the aggressiveness of your cancer. The higher your score, the more likely your cancer will grow and spread rapidly.

I've been diagnosed with prostate cancer. What next?

Dr Wong advises patients to stay calm and recognise that the chances of remission are high, especially for early-stage cancers. Now that cancer has been detected, you can begin treatment.

"The good news is that once you find the right urologist and stick to the treatment protocols, which are very well defined, the outcome will be much better than you expect," he says.

What are my treatment options for prostate cancer?

Monitoring

If the cancer mass is small and hasn't spread beyond the prostate, your urologist will probably recommend a wait-and-see approach. This will include regular screening to see if the cancer gets bigger.

If your urologist considers that the cancer is likely to spread, you will be recommended treatment. This could come either in the form of non-invasive therapies or robotic radical prostatectomy, which is a procedure to remove the prostate gland.

"In cancer control for early prostate cancer, robotic radical prostatectomy is definitely deemed as one of the optimal choices," Dr Wong explains.

Robotic radical prostatectomy

The surgery to remove your prostate gland can take up to 3 hours and 30 minutes to perform, and is carried out through 5 small incisions in the abdominal wall. You'll have to stay in hospital for 2 – 3 nights but most patients recover rapidly. When you are discharged, you'll be sent home with a urinary catheter, which is a small tube inserted in your bladder so you can go to the bathroom without disturbing the healing process.

Side effects to expect

You may experience urinary incontinence for 3 – 4 months before making a full recovery. You may also experience erectile dysfunction, but with proper management, counselling, and medication, recovery from this should take between 9 – 12 months.

Non-invasive therapy

If you don't want to undergo surgery, your urologist may recommend 7 – 8 weeks of an outpatient course of radiotherapy to shrink the cancer and prevent it from relapse. This would probably be performed for 20 minutes each weekday.

If your cancer is more advanced and has spread to your lymph nodes or bones, then Dr Wong considers treatment to be "very straightforward", and responsive in almost 3/4 of patients. You will undergo hormonal therapy to shrink the cancer in the prostate gland and other affected areas. This might be followed up with radiation therapy to further reduce the chance of relapse.

While this treatment can last up to 2 – 3 years, eventually your prostate cancer could relapse and not respond to further hormonal therapy. The search is now on across the world for other forms of therapy to manage the disease.

To learn more about prostate tests and treatments, speak to a specialist.