Health x Wellness

Prostate cancer 101

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This is part one in a series contributed by Dr Jay Lim, a urologist about prostate cancer.

According to the latest statistics on SingStat, there are 1.8 million residents in Singapore born between 1965 and 1990 (aged 33 to 58).

Now, since only half of the population have a prostate (yes if you pee standing, read on..), that is still a sizable 900,000 residents to cover.


Unfortunately, as most men need our wives, daughters, partners and maids to take care of us, it still means I will need to reach out to 900,000 men who understand but don’t register and 900,000 women readers who register but don’t understand. Sigh.

Modelling our vaulted education system, I will make understanding prostate cancer as simple and enjoyable as possible so that, at the end of this read, you can answer some basic questions and pass Prostate Cancer 101 with flying colours!

Primary school level question:

● Who has this thing called the prostate?
● What is the prostate, and why do we need it?
● How do I take care of it, and when?
● What can go wrong with growing up with my prostate?

Bonus extra mark question:

● What sickness can a prostate get?
● When do I need to worry?
● What do I need to look out for?

Gifted Education Programme (GEP) questions:

● Can you prevent Prostate Cancer?
● Benign Prostate Hyperplasia and PSA
● How to check for Prostate Cancer?
● Prostate cancer and its treatment options.

The prostate is a walnut-sized organ that sits at the opening of the bladder and is located between the bladder and the urethra. For most of our lives, it does not bother men as it is deep inside the body. The prostate is crucial to the reproductive system as it provides nourishment to the sperm as it exits our body and allows sperm to live long enough to swim up and fertilise the egg. Without this organ, humans would cease to exist.

Another important by-the-way role of the prostate is that the internal sphincter sits within the prostate (imagine a door that opens and closes), and removing or disturbing the prostate effectively reduces the control men have over the bladder and our reproduction function as sperm flows backwards into the bladder during ejaculation instead of outwards. This is the reason why the prostate is essential, in case you are wondering why we cannot remove it once we finish having kids.

Like any other organ in our body, it can get infected and unhappy at times. Prostatitis is the infection/inflammation of the prostate. It is one of the most common issues that can trouble young men below 50. The symptoms include painful urination, blood in the urine, fever, and a vague tenderness between the perineum (between anus and scrotum). Risk factors for this condition include inadequate hydration, diabetes, urinary stones and, in some cases, sexually transmitted diseases.

Prostate cancer

There are four main types of prostatitis, and acute bacterial prostatitis accounts for the majority under 50 years old. While painful, the treatment for this condition is a course of oral antibiotics for two weeks and is self-resolving in most cases.

Benign prostate hyperplasia (BPH) occurs when our ever-growing prostate causes the opening of the bladder to narrow and blocks the urine flow. The good news is most of the XY generation would not need to be worried about the prostate as they grow slowly. BPH usually occurs after the age of 50 and may trouble us much later in life when we are in our 60s or later.

In short, under 50, prostatitis or urinary infections are going to be your main issue. BPH symptoms, which include poor flow, terminal dribbling, and nocturia (waking up more than twice at night), can occur starting from 60 years old onwards, while prostate cancer usually affects men over the age of 50.

There will be exceptions to this rule, and it’s always important to see your doctor or (better still) a urologist who specialises in the urinary tract after 45 years old to understand your own body better.

In many instances, you are generally lost and forced to backtrack when you or your relatives complain about these sudden discomforts and struggle to figure out who to visit, only to find out there is usually a waiting time involved.

Prevention is much better than cure in Urology. Peeing painful, bloody urine is not for the faint-hearted.

prostate cancer

Troubling as it is, prostatitis and BPH are benign conditions that can be treated effectively with a whole gamut of lifestyle, oral medications or surgical ways. These diseases can make you very sick, especially if you have other significant medical conditions like diabetes or a smoking history. Prostatitis and BPH can land you in hospital and can even cause death. However, in most cases, if you see a doctor early or have a go-to Urologist, you can resolve the issue quickly and safely.

Prostate cancer is a malignant condition that can creep up to men silently. It was the 3rd most common cancer (incidence) in Singapore between 2010 and 2014 but was the 6th highest cause of death (mortality) in men during the same period. The GEP kids amongst us would have picked up the discrepancy between incidence and mortality. Other cancers like lung and colorectal cancers are ranked 1st/2nd in incidence as well as mortality in Singapore between 2010-2014. In other words, these cancers are deadly and have a universally poor outcome if not diagnosed early. This is not the case for prostate cancer.

The silver lining for prostate cancer is that it is a slow-growing cancer, and even if you are diagnosed with prostate cancer, it is not certain that you will die from it. In fact, it is so slow-growing that a common adage amongst urologists is that we tell patients, “You will die WITH prostate cancer and not FROM prostate cancer”.

Not all prostate cancer requires treatment primarily because it usually presents in your 60s to 80s. If you are in your 80s, remain well and not bothered by it (asymptomatic), you can generally leave the cancer alone. Prostate cancer is one of the few cancers in the medical world, that a passive treatment option coined “Watchful Waiting” is featured regularly.

That is not to say that we can ignore this condition, as it is still common enough to cause more deaths than leukaemia, kidney cancers and lymphoma. Hence, the key to surviving your prostate is to find it early and figure out if your prostate cancer is the wolf hiding amongst the sheep.

Article contributed by Dr Jay Lim Kheng Sit, Urologist, PanAsia
Surgery Group.

Dr Lim obtained his Bachelor of Computing from the National University of Singapore in 2005 and completed his graduate medical degree from the University of Sydney in 2009. He completed his Urology Surgical Training in 2017 and was interested in stone-related research, prevention and surgery. Dr Lim believes communication in English, Mandarin and dialects is critical to a robust Doctor-Patient relationship. A keen innovator, he was awarded the Singapore-MIT innovation fellowship in 2017. He is actively involved in the medical device innovation scene and holds a patent for his work.

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