News & Articles

Movember 2018

This month, we’re turning the spotlight on Men’s Health as Dr. Chong answers important questions on two of the biggest health issues faced by men: prostate cancer and testicular cancer.

 

PROSTATE CANCER

What is prostate cancer and who is at risk?
Prostate cancer is the 3rd most common cancer in Singapore men and the most common non-skin cancer for men in North America. It usually occurs in men who (a) are older than 50 years old, (b) have fathers or male relatives with prostate cancer, and (c) belong to ethnicity groups like African-Americans.

 

What are the signs and symptoms of prostate cancer?
Unfortunately, many prostate cancer patients do not have symptoms. Prostate cancer is detected mainly through an abnormal blood test cancer marker called prostate specific antigen (PSA). In some patients who have symptoms, these include frequent urination, weak urine stream, blood in the urine, or waking up at night to pass urine.

 

Although uncommon, a few patients who come to see the doctors already have stage 4 prostate cancer with back pain or leg weakness, if the cancer has spread to their spine and bones.

 

How do you prevent prostate cancer?
There are many factors that cause prostate cancer, so there isn’t any single way to prevent cancer. One of the options is to eat more food with lycopene, which may reduce the chance of prostate cancer. Some food with lycopene include tomatoes and watermelon.

 

What are the treatment options for prostate cancer and how do you choose?
Once diagnosed with prostate cancer, the first step is to do cancer staging to find out if it has spread outside the prostate gland. Treatment will be based on the stage of cancer.

 

In early stages where the cancer has not spread, one of the options include: (a) active surveillance which requires monitoring of how active or dangerous the cancer is.

 

Other options include (b) surgery to remove the prostate gland out of the body, or (c) giving radiation therapy to kill the cancer cells.

 

In late stages where the cancer has spread, there are many good treatment choices even if it is Stage 4 cancer. The choices include (d) hormone therapy to reduce the “food supply” of the cancer, (e) chemotherapy to kill off the cancer, or (f) radio-isotope therapy that can attack prostate cancer cells that have already spread to the bone.

 

What are some of the side effects of treatment?
Do remember that each treatment option has its own advantages and disadvantages. Please discuss them with your doctor to understand properly before making the right choice for yourself.
Some of the side effects of each treatment are:

 

1. active surveillance – anxiety, repeated PSA blood test and repeated prostate biopsies to monitor if the cancer has changed or worsened.
2. surgery – urinary incontinence and erectile dysfunction. Thankfully modern use of da Vinci robotic operating system allows more precise surgery and improves our accuracy in stitching during operation.
3. radiation therapy – urinary frequency, increased urination at night, blood in urine and rectum.
4. hormone therapy – mood changes, weak bones (osteoporosis) and heart problems (ischaemic heart disease).
5. chemotherapy – reduced body immunity and tiredness.
6. radio-isotope therapy – anaemia.

 

TESTICULAR CANCER

What is testicular cancer and who is at risk?
Testicular cancer is the most common cancer in young adult men between 20 and 35 years old. It appears as a hard lump in the testis. Although any men can get testis cancer, those with higher cancer risks are patients who had surgery as young boys for undescended testis.

 

What are the signs and symptoms of testicular cancer?
The normal testes should feel slightly firm, just like a hardboiled egg without an eggshell. Testicular cancer usually manifests as hard lumps that feel like a pebble.

 

How to check for testicular cancer yourself?
After a warm shower, use both hands and gently pinch your testis using your thumb and index finger. If there is a hard lump within your testis, please see a medical doctor for proper medical assessment.

 

What are the treatment options for testicular cancer and how do you choose?
The first few steps to treat testicular cancer are: (a) find out the type of testis cancer cells, (b) blood tests for cancer tumour markers and (c) CT scans and imaging for cancer staging to find out if cancer has spread outside the testis.

 

The choice of treatment is based on the (a) type of cancer cells found inside the testis and (b) stage of cancer.

 

Depending on the types of testicular cancer cells, and whether it has spread to other parts of body, one or more of the following treatments may be given: (a) active surveillance, (b) surgery, (c ) radiation therapy or (d) chemotherapy.

 

What are some of the side effects of treatment?
Do remember that each treatment option has its own advantages and disadvantages. Please discuss them with your doctor to understand properly before making the right choice for yourself.

 

Some of the side effects of each treatment are:
1. active surveillance – repeated blood tests on tumour markers, repeated CT and X-ray scans to monitor possible spread of cancer, and cancer may become worse during observation time period.
2. surgery – changes in ejaculation (although sex drive and erection are maintained), leg swelling and need for major surgery.
3. radiation therapy – diarrhoea, develop another new cancer and blood in stools.
4. chemotherapy – infertility, reduced body immunity and hair loss.

 

ERECTILE DYSFUNCTION

Some treatments for prostate cancer and testicular cancer can cause erectile dysfunction. What are some ways to treat erectile dysfunction?
Erectile dysfunction related to cancer treatment can be managed with these options:

 

1. Couples counselling for patient and his partner.
2. Oral medication to improve blood flow into penis (e.g. Viagra, Cialis).
3. Injection of medicine (e.g. intracavernosal prostaglandins).
4. Surgery to improve erection (e.g. penile implants).

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