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Understanding Prostate Cancer
High-Risk Age Groups
Latest Statistics On Prostate Cancer Incidence And Mortality In Hong Kong
Prostate cancer is the third commonest cancer of men in Hong Kong. In 2022, there were 2 758 new cases of prostate cancer, accounting for 16.0% of new cancer cases of men in Hong Kong. The median age at diagnosis was 71 years. The crude annual incidence rate per 100 000 men was 82. Prostate cancer is the fourth leading cause of cancer death among males in Hong Kong. In 2022, a total of 519 men died from this cancer, accounting for 6.2% of all cancer deaths in men. Compared to other common cancers of men, the number of newly diagnosed cases has grown fast in recent years, increasing by 69% from 2012 to 2022.
Prostate malignant tumours develop slowly, without obvious clinical symptom in the early stage. As a result, quite a number of patients discover the disease in the intermediate to advanced stage, thus affecting the treatment outcomes. According to the Cancer Registry statistics, the overall five-year relative survival rate with prostate cancer was 84%. The rates were very high (>97%) in stage I to III but fell to 45% for stage IV.
Urinary Problems
What Are The Common Symptoms Of Prostate Cancer?
Prostate cancer typically grows at a relatively slow pace, and in its early stages, noticeable warning signs are often absent. As a result, the tumour may exist in the body for years without detection. However, as the cancer enlarges or begins to spread to other areas, patients may experience the following symptoms:
- Frequent urination, particularly worsening at night
- Difficulty passing urine
- Pain or burning sensation during urination or ejaculation
- Blood in urine or semen
- Persistent dribbling after urination
If cancer cells have spread to the bones, spine, or pelvis, patients may also experience stiffness or pain, along with fatigue, loss of appetite, and gradual weight loss.
It is important to note that similar symptoms can occur due to benign prostate enlargement. Therefore, early medical evaluation is essential for accurate diagnosis if any of these signs appear.
Reproductive System
What Are The Common Causes Of Prostate Cancer?
The prostate gland is part of the male reproductive system, located between the bladder neck [Note 1]and the urethra, with a shape resembling a walnut. It secretes a white fluid that mixes with sperm to form semen. Generally, prostate enlargement is common in older men, with most cases being benign. However, if cells undergo genetic mutations and develop into malignant tumours, prostate cancer occurs.
Primary High-Risk Factors
What Are The High-Risk Factors For Prostate Cancer?
Various high-risk factors influence the distribution of prostate cancer cases. As previously mentioned, most patients are 65 or older, which remains the most significant factor. Other contributing circumstances include:
- Having male family members (such as a father or brother) with a history of prostate cancer
- Long-term consumption of high-calorie and high-fat foods
- Chronic lack of physical activity
- Smoking habit
- Previous history of prostate abnormalities
Given these risk factors, preventing prostate cancer requires cultivating healthy dietary habits. Increasing intake of high-fibre, low-fat foods (such as soy products and fresh fruits and vegetables) can help prevent or delay the development of prostate cancer.
Severe Conditions
What Are The Potential Complications And Metastasis Pathways Of Prostate Cancer?
If prostate cancer remains undetected and untreated, the condition may progress severely. One potential complication is metastasis, where cancer cells spread to other body parts. The tumour may travel through lymphatic vessels to nearby lymph nodes, or metastasise to bones such as the pelvis, lumbar spine, femurs, and ribs—often causing significant pain.
Additionally, prostate cancer can spread to vital organs, including the lungs, pleura, liver, kidneys, adrenal glands, and brain.
Common Diagnostic Methods and Risks
Suspect Prostate Cancer? What Are The Diagnostic Methods For Prostate Cancer?
- Digital Rectal Examination (DRE) The doctor wears gloves and inserts a finger into the patient’s rectum to check for abnormal lumps in the prostate.
- Blood Test (PSA Test) Measures the level of prostate-specific antigen [Note 2] in the patient’s serum. Normal levels should be below 4ng/ml. Levels between 4- 10ng/ml may indicate prostate enlargement or early-stage prostate cancer. A reading of 10ng/ml or higher strongly suggests prostate cancer, requiring further testing.
- Transrectal Ultrasound (TRUS) A small probe is inserted into the rectum to closely examine the prostate through real-time imaging, allowing detailed analysis for abnormalities.
- Biopsy During the ultrasound procedure, a needle is used to extract tissue samples from multiple areas of the prostate for cellular analysis, determining whether the growth is benign or malignant.
- Cystoscopy A flexible, thin tube with an endoscope is inserted through the urethra into the bladder to examine the lower urinary system, including the urethra, prostate (in men), and bladder interior for abnormalities.
- Bone Scan or X-ray A small amount of gamma-ray-emitting substance is injected into the patient’s arm vein to identify cancer locations. Abnormal bone areas absorb more radioactive material than healthy tissue, which is visible in the resulting images.
- Abdominal Ultrasound, CT Scan or MRI Generates detailed internal images to detect the potential spread of prostate cancer cells to other body parts.
- Chest X-ray Checks for possible metastasis to the lungs.
After a comprehensive evaluation through these tests, doctors determine the optimal treatment approach. Given prostate cancer’s typically slow growth rate (often not immediately life-threatening) and the advanced age of most patients, physicians carefully consider multiple factors: the patient’s overall health, tumour extent, PSA levels and their rate of increase.
Additionally, doctors assess tumour aggressiveness using the Gleason scoring system (evaluating cancer cell differentiation). Higher Gleason scores indicate greater risk:
- Low Risk Cancer involves less than half of one prostate lobe, PSA <10ng/ml, and Gleason score ≤6.
- Intermediate Risk Tumours are not classifiable as either high or low risk.
- High Risk Cancer invades surrounding prostate tissues, PSA >20ng/ml, Gleason score ≥8.
Four Major Treatment Approaches
What Are The Latest Treatment Trends For Prostate Cancer?
Prostate cancer can be managed through the following four treatment options:
- Active Surveillance This approach is only suitable for low-risk, early-stage prostate cancer. Doctors conduct regular monitoring (e.g., biannual check-ups) to track PSA level increases. Patients only require radical treatment if the tumour growth accelerates. This method helps some patients avoid unnecessary treatment and delays potential side effects, even if other therapies become necessary later.
- Radical Prostatectomy Surgical removal is appropriate for patients under 75 years old without severe health conditions and with a life expectancy exceeding 10 years. The procedure involves removing the prostate along with surrounding tissues (including seminal vesicles) and potentially nearby lymph nodes, while preserving the nerves controlling penile erection. However, if cancer is adjacent to or has invaded these nerves, they must also be excised.
- Laparotomy
Surgeons make a vertical incision from the navel to the pubic bone to access and remove the prostate through this large opening.
- Laparotomy
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- Minimally Invasive Procedure Multiple small incisions allow insertion of specialised instruments for prostate removal, with the surgeon guiding the procedure via video monitoring. This reduces postoperative pain.
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- Robotic Surgery Surgeons operate robotic arms through small incisions. The robotic system provides enhanced visualisation (3D, HD, 10x magnification) and improves precision through flexible instrument control.
Following prostatectomy, patients may experience urinary incontinence. Approximately 15% of patients aged 70+ develop persistent incontinence, while fewer than 50% of patients under 50 experience permanent incontinence. Additionally, as the surgery may affect or remove tissues responsible for erectile function, postoperative erectile dysfunction is common. However, many patients can maintain sexual function through oral medications, vacuum erection devices [Note 3], or intracavernosal injections.
- Radiation Therapy Can be categorised into external and internal forms:
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- External Beam Radiation Suitable for various risk categories. The process resembles X-ray imaging – patients lie on a machine delivering high-energy rays to destroy cancer cells and prevent their division. The 7.5-week regimen involves five sessions (20-30 minutes each), requiring neither anaesthesia nor hospitalisation. However, the rectum’s proximity to the prostate may lead to minor bleeding or ulcers due to radiation exposure.
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- Brachytherapy (Internal Radiation) Only appropriate for low-to-intermediate risk cases. Involves implanting radioactive seeds directly into the prostate for continuous low-dose radiation. These seeds gradually lose radioactivity and remain permanently. While the procedure is brief, its limited radiation coverage to surrounding tissues and relatively scarce clinical experience in Hong Kong restricts its prevalence.
- Hormone Therapy This treatment serves multiple purposes: it can complement radiation therapy to eradicate higher-risk tumours, alleviate symptoms of advanced prostate cancer that has metastasised to other areas, and stand as the sole viable option for elderly or frail patients unsuitable for surgery or radiation. In essence, the therapy works by disrupting male hormones to shrink prostate tumours. The most direct and permanent approach involves surgical removal of the testicles (orchiectomy). Alternatively, patients may opt for quarterly injections of medication that interferes with pituitary gland secretions, thereby indirectly suppressing testosterone production. However, all forms of androgen deprivation therapy inevitably induce various side effects, including fatigue, osteoporosis, elevated blood sugar and lipid levels, and weight gain. Some patients may also experience reduced libido, erectile dysfunction, and muscle atrophy.
Healthy Living
Personal Care For Managing Post-Operative Side Effects Of Prostate Cancer
After treatment, patients should maintain a balanced diet with reduced fat intake and moderate daily exercise to preserve physical fitness. These habits help strengthen immunity and lower recurrence risks. Overweight patients should prioritise weight management to protect cardiovascular health. Regarding sexual health, some patients may experience erectile dysfunction and can maintain intimacy with partners through alternative expressions of affection, such as hugging and caressing.
Further Understanding
Read More
Sources:
Hospital Authority
Cancer Foundation
Hong Kong Anti-Cancer Society
Mayo Clinic
Cancer Online Resource Hub
▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.
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