Prostate cancer is a malignant tumor that grows in the prostate, a walnut-sized gland below the bladder in men that produces semen. Most prostate cancers are slow-growing but there are aggressive cases, and the cancer can spread to other parts of the body, especially the bones and lymph nodes.

According to a Singapore Cancer Registry interim report for the period from 2006 to 2010, it is the third most common cancer for men in Singapore, with more than 500 cases diagnosed every year in the last five years here.


Signs and Symptoms

In many cases, there are no symptoms, and it is believed that as many as 80 per cent of men who reach the age of 80 will have prostate cancer. As most cases are slow-growing, many will, in fact, die of other ailments of old age without ever realising that they have the cancer.

When symptoms do emerge in more advanced stages, they include weight loss, pelvic pain, back or hip pain and urinary difficulties, such as burning or pain during urination, the inability to urinate or blood in the urine.


Diagnosis & Assessment

Screening Tests For Early Detection

  • Digital Rectal Examination (DRE) – This may be carried out by a doctor. Using a gloved finger to examine the rectum, he may be able to feel a lump or growth in the prostate.
  • Prostate-Specific Antigen (PSA) Test – This is the most common initial test for prostate cancer. It tests the level of PSA – a protein produced by the cells in the prostate gland – in the blood. The higher the level, the more likely cancer is present, although other factors may cause an elevated PSA reading as well.

Test To Diagnose Prostate Cancer

  • Prostate Biopsy – If prostate cancer is suspected, a biopsy – removal of sample tissue – is carried out, after which, if the result is positive, a bone scan or computer scanning of the pelvis is needed to determine the extent of the cancer.
  • Transrectal Ultrasound – This uses sound waves to visualize the prostate gland. This is most often used during a biopsy to guide the needles into the part of the prostate gland where tumor is suspected.

Tests After Cancer Is Diagnosed

  • PSA Levels – Once cancer is diagnosed, PSA levels may help determine its extent. If PSA levels are lower than 20ng/mL, it is likely that the cancer has not spread to distant sites. PSA levels over 40ng/mL are strong indicators that cancer has spread to other parts of the body.
  • Tests for Metastasis – If the biopsy indicates cancer, other tests will be done to determine how far the cancer has spread. Bone scans and x-rays may reveal whether the cancer has invaded the bones. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can further pinpoint the location of the cancer.

Grading Prostate Cancer

Prostate cancer is graded according to the Gleason system, which measure how well or how poorly organized the cancer cells are, under the microscope.

Grade 1: Cancerous tissue looks much like normal prostate tissue.
Grade 2 to 4: Some cells look like normal cells, some do not. With features that vary in between the two extremes.
Grade 5: Cancer cells and growth patterns look very abnormal.

Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added together to yield the Gleason score between 2 and 10.

A Gleason score of less than 6 indicates a less aggressive cancer. A score of 7 and above is considered aggressive and more likely that the cancer will grow and spread quickly.


Treatment & Care

How Is It Treated?

In some cases, because prostate cancer may take many years to progress, while treatment does have its risks, doctors may choose to simply monitor the tumor rather than treat it immediately. This is because treatment depends on factors such as the stage of the cancer, symptoms, age, and general health of the patient.


When treatment is decided on, it could include surgical removal of the prostate gland if the cancer is localized. Chances of a full recovery are high in such cases but possible side effects include urinary incontinence and impotence.

Radiation therapy

By using high-energy rays to target and kill cancer cells. This may also be used when the cancer is localized.

Hormonal therapy

This may be used to treat cancer that has spread beyond the prostate to counter the effects of testosterone and slow the growth of the cancer.


At times, chemotherapy is used to alleviate symptoms of prostate cancer if other treatments prove ineffective.


What Is The Best Approach To Care?

The development of a treatment plan by a multi-disciplinary team – surgeons, pathologists, radiologists, medical & radiation oncologists, radiologists, social workers and nurses to diagnose, treat and manage the condition has shown to improve the outcome for patients with cancer.

Who Is At Risk Of Prostate Cancer And How Can One Prevent It?

In Singapore, Chinese men have double the risk of getting prostate cancer compared to Malays and Indians, says an information paper on prostate cancer released in 2011 by the National Registry of Diseases Office.

Age is another factor, with men in their 40s having a risk of just one in 200,000, in their early 50s, it jumps to 12 per 100,000, while men in their 60s have a 12 out of 10,000 chance of being diagnosed with prostate cancer.

People, who are obese, eat excessive amounts of meat or food high in animal fat, men who began having sex at an early age, have a history of sexually-transmitted diseases or multiple sexual partners, also have an increased risk of prostate cancer. Also in the higher-risk group are men with a family history of prostate cancer.

A healthy lifestyle, with lower meat consumption, therefore, goes a long way in helping to prevent prostate cancer as well as other cancers.


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