Prostate Cancer Treatment in Singapore With Radiation Therapy

Medically reviewed by Dr Johann Tang, Senior Consultant Radiation Oncologist

As the 3rd most common cancer diagnosed in males in Singapore, prostate cancer has been increasing in incidence over the last few decades. Read on to learn more about the symptoms and risk factors of prostate cancer, as well as various types of prostate cancer treatment in Singapore, including radiation treatments such as Imaged Guided Radiotherapy (IGRT), proton therapy, and brachytherapy.

What is prostate cancer? 

Prostate cancer is cancer of the prostate gland, which is located below the bladder near the urethra in males. Some of the symptoms of prostate cancer include frequent urination at night or an inability to urinate, pain or a burning sensation when urinating, blood in the urine, bone pain, as well as unexplained weight loss and loss of appetite. The risk of prostate cancer increases in men who are over the age of 50, as well as in those who are obese, eat a diet high in fat, and have a family history of prostate cancer. 

How is prostate cancer diagnosed? 

Early detection is crucial for effective prostate cancer treatment. Screening tests can help detect prostate cancer early.

• Digital Rectal Exam (DRE)

During a DRE, a doctor will insert a gloved, lubricated finger into the patient’s rectum to inspect the prostate and check for any irregularities.

• PSA Blood Test

The prostate gland produces a substance known as prostate-specific antigen (PSA), which can also be found in the bloodstream. Elevated levels of PSA in the blood may indicate the possibility of prostate cancer.

• Ultrasound

A small probe will be inserted into the patient’s rectum to create images of the prostate gland using sound waves. It is used to guide a biopsy of the prostate.

• Biopsy

This procedure involves removing sample tissues from the prostate gland for analysis to determine the presence and aggressiveness of cancer cells. If the result is positive for cancer, imaging such as Magnetic Resonance Imaging (MRI) and/or PSMA PET SCAN may be required to ascertain the extent of the cancer.

Who Is at Risk for Prostate Cancer?

Certain factors increase a man’s risk of developing prostate cancer. These include:

Age: Men over the age of 50 are at a higher risk. The likelihood of diagnosis also increases significantly with age.

Family History: A family history of prostate cancer, particularly if a father or brother was diagnosed, increases risk. Men with relatives who have had breast cancer may also be at a higher risk due to genetic links.

Ethnicity: Prostate cancer is more common in men of African descent. Asian men, however, have a lower incidence rate.

Diet and Lifestyle: A diet high in red meat and high-fat dairy products increases the risk. The same goes for smoking, obesity, and lack of exercise.

High Testosterone Levels: Men with higher levels of testosterone may have an increased risk due to the hormone stimulation of prostate cells.

Symptoms of prostate cancer

Symptoms of prostate cancer include:

• Frequent urination at night

• Inability to urinate

• Weak or interrupted flow of urine

• Pain or a burning sensation when urinating

• Blood in the urine or semen

• Pain in the back, chest (rib), hips, pelvis, or other bony areas

• Unexplained weight loss and loss of appetite

• Painful ejaculation

• Erectile dysfunction

Take charge of your treatment today. Explore other prostate cancer treatment options in Singapore.

Types of Prostate Cancer

Understanding the type of prostate cancer is crucial for determining the most effective prostate cancer treatment in Singapore. Here are the different types, each with varying levels of aggressiveness:

• Adenocarcinoma

Originating in the gland cells of the prostate, it is the most common type, which accounts for the vast majority of cases.

• Small Cell Carcinoma

A rarer and more aggressive form of prostate cancer that does not typically produce PSA (prostate-specific antigen), which can make it harder to detect early.

• Transitional Cell Carcinoma

It usually starts in the bladder but can also affect the prostate, despite being a rare type, as compared to adenocarcinoma.

• Sarcomas and Neuroendocrine Tumours

Sarcomas arise in the connective tissue of the prostate, while neuroendocrine tumours develop from hormone-producing cells. Both are rare forms of prostate cancer.

Stages of Prostate Cancer

Prostate cancer progresses in distinct stages, which are crucial for determining the best type of prostate cancer treatment in Singapore:

Stage 1:

• Cancer is confined to the prostate and is not detectable by physical exams or imaging.
• Often found incidentally or through PSA testing.
• Excellent prognosis with early intervention.

Stage 2

• Cancer is still contained within the prostate but may involve more tissue.
• Treatment may involve surgery, radiation, or both. Hormonal therapy is also considered for some cases.

Stage 3

• Cancer has spread beyond the prostate to nearby tissues, such as the seminal vesicles.
• Treatment often involves radiation, sometimes combined with hormonal therapy, to reduce cancer spread.

Stage 4

• Advanced-stage cancer has spread to distant lymph nodes, bones, or other organs.
• Treatment usually involves a combination of therapies, including radiation, hormone therapy, chemotherapy, and possibly surgery.

When should you seek a doctor?

However, it should be noted that prostate cancer cells usually grow slowly compared to other forms of cancer. It can take up to 15 years before a tumour gets sufficiently large to cause symptoms. By the time these symptoms surface, the cancer may already be advanced. 

With that said, some precancerous or cancer cells may already be present at an early stage. Therefore, it is vital to undergo test screenings regularly and understand and spot the symptoms early. This way, patients can seek appropriate prostate cancer treatments promptly. If you have experienced any of the symptoms of prostate cancer shared above, please consult a doctor immediately.

Ways to Prevent Prostate Cancer

Although there is no surefire way to prevent prostate cancer, certain lifestyle changes can lower the risk. Prevention strategies include:

Dietary Changes: Eat a diet rich in fruits, vegetables, and whole grains, and limit your intake of red meat and high-fat dairy products.

Regular Exercise: Not only does physical activity improve overall health, but it also helps maintain a healthy weight, which is important in reducing the risk. 

Screening and Early Detection: Regular PSA tests and digital rectal exams (DRE) are recommended for men over 50 or those with a family history of prostate cancer. With early detection, a more effective prostate cancer treatment in Singapore can be carried out. 

Quitting Smoking: Smoking increases the risk of several cancers, including prostate cancer

Healthy Weight Management: Obesity has been linked to a higher risk of aggressive prostate cancer. Maintaining a healthy weight through diet and exercise is a key preventative measure.

What are the available treatments for prostate cancer?

Prostate cancer can be treated using surgery, radiation, or observation depending on the Age of patient and stage of the cancer. These treatment options should be discussed with your cancer specialist.

Prostate cancer surgery is often recommended for localised prostate tumours. For more advanced stages, radiation therapy combined with hormonal therapy, is the preferred form of prostate cancer treatment in Singapore.

What radiation treatments are used for prostate cancer?

Radiation can be used to treat prostate cancer by delivering radiation that damages the DNA of cancer cells and halts their growth. Your doctor may recommend External Beam Radiation Therapy (EBRT) or Proton Therapy to precisely target and destroy cancer cells in the prostate gland while minimising damage to surrounding tissues. Brachytherapy is another form of radiotherapy your doctor may suggest, delivering internal radiation directly to the prostate as part of prostate cancer treatment in Singapore.

External Beam Radiation Therapy (EBRT)

External Beam Radiation Therapy (EBRT) is a treatment for prostate cancer using high-energy X-rays or particles to destroy cancer cells. It is typically delivered using imaging techniques to ensure precise targeting of the tumour, thereby sparing healthy surrounding tissue as much as possible.

To improve the precision of radiation delivery, Image-Guided Radiation Therapy (IGRT) which involves the use of imaging technologies such as CT scans or MRI both before and during the treatment sessions is used. This allows for real-time visualisation of the prostate and any movements it might make due to normal physiological functions, like bladder filling or rectal gas. By adjusting the radiation beams accordingly, IGRT enhances the accuracy of the treatment, which can improve outcomes and reduce side effects.

To reduce the side effects of treatment, hydrogel spacers are used to reduce the radiation rectum side effects.  

Another form of EBRT is  Volumetric -Modulated Radiation Therapy (VMAT). VMAT allows for the modulation of radiation doses, targeting the tumour with varying intensities from multiple angles. This technique maximises the dose to the tumour while minimising exposure to the surrounding normal tissues.

Proton Therapy

Proton therapy is a form of radiation treatment that uses protons instead of X-rays to treat prostate cancer. Protons are positively charged particles that have unique physical properties allowing them to deposit the majority of their energy directly in the tumour with zero or minimal exit dose, which spares the surrounding healthy tissues.

The special properties of Proton beam reduces the risk of side effects commonly associated with radiation treatments. It is recommended for paediatric cancers, brain tumors, head and neck cancers, sarcomas and prostate cancers. For further information on the approved use of Proton therapy in Singapore, please refer to MOH approved indications for Proton Therapy here.

Brachytherapy

Brachytherapy in Singapore is administered either via permanent radioactive seed implants in the case of Low Dose Rate (LDR) treatments, or by moving a radioactive source temporarily during a session for High Dose Rate (HDR) treatment. LDR and HDR differ in terms of the duration that the radioactive sources are placed in proximity to the cancer, which influences the total dosage of radiation received during each treatment session. HDR radiation treatment for prostate cancer offers more precise targeting and stronger treatment while also removing the risk that can arise with seed implants moving away from their intended positions due to swelling. 

Seeking quality prostate cancer radiation treatment in Singapore? Get in touch with us today to arrange for an appointment and consultation.