Learn about Prostate Cancer


Q1. What is the prostate gland? What are its functions?


As part of the male reproductive system, the prostate gland is located below the bladder and above the penis. The urethra passes through the prostate gland and connects the bladder. When the bladder is filled with urine, the bladder sphincter muscles relax and allow urine to flow via the urethra.




The prostate’s function is to produce seminal fluid. As sperms are produced in the testicles, the fluid in which the sperms are nourished is produced by the prostate gland. Seminal fluid contains both the sperms and fluid. In case of prostate inflammation, tumour or enlargement, the urethra is compressed, causing multiple symptoms such as urination difficulties, blood in urine, pain during urination, frequent urination, etc.




Q2. Can prostate cancer be predicted?


Prostate cancer is a common disease.  It is the third most common male cancer in Hong Kong and the fifth leading cause of cancer deaths in men. As a common and serious condition, prostate cancer has no obvious symptoms in its early stage. If symptoms occur, they are similar to those of enlarged prostate or age-related urinating problems, making them less distinctive until the condition deteriorates with pain, weight loss, blood in urine, etc.  As prostate cancer is difficult to treat if detected at advanced stage, is there any way to identify the risks as early as possible?




The answer is yes.  The risk can be assessed with a simple blood test using Prostate Specific Antigen (PSA), a tumour marker for prostate cancer.  It is recommended for all males aged between 50 and 75 with or without symptoms.  If symptoms occur, proper assessment or consultation with your Family Doctor or an Urologist should be arranged as early as possible.




Q3. Does prostate cancer come with age? Do I need to see a doctor for prostate cancer when old?


Some people believe that prostate cancer is not something to be afraid of. As it is common in the elderly, we should live with it instead.  This is definitely wrong.  As I said earlier, statistics show that the incidence and mortality rates of prostate cancer are high. As the fifth most common cancer killer in the local male population, it not only affects one’s health but is life-threatening.  So where does the idea of “living with cancer” come from?  It may originate from the days when prostate cancer was mostly diagnosed at advanced stage or too late. Thanks to better treatment options with lesser side effects, nowadays prostate cancer can be cured. If you are worried about, or already diagnosed with prostate cancer, stop believing in the “living with cancer” concept. Seek consultation with a specialist at the earliest opportunity.   




Q4. How is prostate cancer treated?  Is immediate removal required?


How can prostate cancer be treated? It usually begins with cancer staging using PET/CT, MRI scan, etc.  Early-stage prostate cancer is curable with 4 treatment options: the first one is active surveillance. To monitor low risk cancers using regular blood tests, MRI scans and biopsy results, and only start treatment if warning signs appear. The second option is minimally invasive surgery, as prostatectomy can be performed using the da Vinci Xi Robotic Surgical System. The third one is radiotherapy, which delivers radiation energy to the prostate gland to kill the cancer cells. The last and the latest treatment is high-intensity focused ultrasound (HIFU). It uses focused ultrasound to destroy the targeted tumour without damaging the rest of the prostate.




Q5. What is the da Vinci Xi Robotic Surgical System? How does it work?


As I said earlier, prostate cancer can be removed using the da Vinci Xi Robotic Surgical System.  It is basically a minimally invasive surgery, in which five small abdominal incisions are made for insertion of cameras and robotic arms. With 3-D and magnified images, surgeons can clearly locate the blood vessels, structures, nerves, etc.  And the robotic arms can rotate 360 degrees with higher flexibility and steadiness than human hands, making them the best option to remove prostate cancer.  During surgery, the whole prostate gland is removed, followed by the reconnection of the urethra and bladder to maintain basic functions. Large-scale studies show that, in terms of prostate cancer removal, minimally invasive surgery can achieve the best outcome with less bleeding and less pain during surgery as well as shorter hospital stay. Urine retention, even sexual function, may be restored after surgery.




Q6. How about High-intensity focused ultrasound (HIFU)? What are the advantages of HIFU?


As one of the latest treatments of prostate cancer, high-intensity focused ultrasound (HIFU) can target and kill cancer cells with focused, high-energy ultrasound beams. Ultrasound is usually harmless and safe, but just like focusing sunlight with a magnifying glass, it can burn things when concentrated on a focal point.  Complemented by other technologies such as MRI in targeting the diseased areas, HIFU can destroy cancer cells with focused, high-energy ultrasound beams while preserving the prostate gland. As a focal therapy, HIFU works differently from minimally invasive robotic surgery and radiotherapy. Instead of treating the whole prostate gland, HIFU preserves the organ by targeting the tumour only. As most of the prostate gland remains intact during treatment, the risk of side effects can be minimised, such as incontinence, sexual dysfunction or damage to the bladder or rectum due to radiation.  However, please note that, as a relatively new treatment, HIFU is not applicable to all types of prostate cancers. It is recommended when prostate cancer is in its early stage, suitably located and small in size. Patients should consult an Urologist before making any decision.

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