It is alarming to think that someone could have advanced prostate cancer and not even know it. In fact, many men in Singapore who are diagnosed with prostate cancer only realise they have the disease once it has already progressed to an advanced stage. Unfortunately, this leaves them with a less favourable prognosis and can make treatment for prostate cancer more difficult.

If you are concerned about prostate cancer, it is important to be aware of the signs and symptoms so that you can get screened and treated as soon as possible by a cancer specialist such as those at OncoCare. This is why this article looks at what prostate cancer is, its symptoms, and the ways in which it can be treated.

Can You Have Stage 4 Cancer and Not Know it?

But before diving into the specifics of advanced prostate cancer, it’s essential to grasp the broader concept of cancer metastasis.

Cancer can spread from its original location to other parts of the body through a process called metastasis. This phenomenon is not exclusive to prostate cancer; it is a common pathway for many cancer types to become more severe and challenging to treat.

Cancer cells can spread in a few ways: by directly invading nearby tissues, by entering the bloodstream and circulating to distant organs, or by travelling through the lymphatic system to reach lymph nodes. And the common cancers that metastasise include breast, colorectal, oesophageal, lung, ovarian, pancreatic, prostate, skin, stomach, and uterine cancers.

The first sites of metastasis typically depend on the primary cancer's location. Common sites for secondary tumours include adrenal glands, bones, brain, liver, lungs, lymph nodes, and the peritoneum.

Interestingly, not all cancers that have spread cause symptoms. In many cases, cancer can advance stealthily, making significant inroads into other organs before any overt signs appear. This is particularly true for stage 4 cancers, which might not manifest symptoms immediately. When symptoms do start to show, they can vary widely based on the metastasis site—from bone pain and neurological symptoms to more generalised signs like severe fatigue and weight loss.

Regarding treatment, the approach to metastatic cancer remains rooted in the origin of the primary cancer. For instance, if prostate cancer spreads to the bone, treatments may still target prostate cancer cells but with additional therapies to manage bone-related symptoms. Treatment modalities may include chemotherapy, hormone therapy, radiation, and surgery, all aiming to control growth and alleviate symptoms of metastatic disease.

What Is Prostate Cancer?

The prostate is a tiny gland located in the pelvis below the urinary bladder. Regarded to be similar in size and shape to a walnut, it is responsible for producing seminal fluid that nourishes and transports sperm in the male reproductive system.

The third most commonly seen cancer amongst men in Singapore, prostate cancer, occurs when prostate gland cells experience uncontrolled growth and become malignant lumps that spread to nearby bodily tissue like the seminal vesicles or the bladder neck.

Statistical data further underscores the significance of this health issue: according to the National Cancer Centre Singapore, covering the years 2018 to 2022, prostate cancer stood as one of the most frequent cancers diagnosed in males, with a total of 7,515 cases registered over this period.

Stages of Prostate Cancer

Prostate cancer is categorised into four stages, each indicating a different level of advancement and spread.

• Stage I: Cancer that is confined to a small area of the prostate. It grows very slowly, is often undetectable through exams or scans, and is usually associated with a low prostate-specific antigen (PSA) level, suggesting that the cancer is not aggressive.
• Stage II: The cancer is still within the prostate but grows more actively. This stage is further divided into two categories:
  • Stage IIA: Found in one side of the prostate.
  • Stage IIB: Spread to both sides of the prostate.
• Stage III: The cancer has grown beyond the prostate and may affect nearby tissues, such as the seminal vesicles (glands near the prostate).
• Stage IV: The most advanced stage of prostate cancer, Stage 4, means that the cancer has spread (metastasised) to distant areas like lymph nodes, bones, or organs such as the bladder, liver, or lungs. This stage often needs more aggressive treatment.

What Are the Common Risk Factors of Prostate Cancer?

Now, when it comes to knowing one’s susceptibility to the disease, it is important to know that the primary risk factor for prostate cancer is age; the older a man gets, the likelihood of developing prostate cancer increases.

In Singapore, specifically, the Singapore Cancer Registry's 2021 Annual Report revealed that prostate cancer was the third most common cancer among men aged 50 to 59, with 526 cases, and the most common cancer among men aged 60 to 69, with a significant increase to 2,506 cases.

Ethnicity also plays a role, with higher incidence rates observed among Chinese males in Singapore. According to the Singapore Cancer Registry Annual Report 2021, prostate cancer was the top cancer amongst Chinese males, with 6020 cases altogether. The exact reasons behind these racial and ethnic disparities remain unclear. However, research in Asia suggests that diets high in red meat, fat, dairy, and eggs may contribute to an increased risk of prostate cancer.

Lifestyle factors, particularly smoking, have also been studied to influence the progression of prostate cancer, potentially leading to more aggressive forms. However, research hasn't clearly shown that smoking causes prostate cancer.

Prostate Cancer Symptoms

With its high level of prevalence amongst Singaporean men, it is essential for males to take note of the possible signs of prostate cancer to ensure they give themselves every chance of early detection of the condition.

Some symptoms associated with prostate cancer include:

• needing to urinate more often
• struggling to urinate
• feeling like your bladder isn't empty
• weakness or swelling in the lower limbs

However, these symptoms don't necessarily mean you have prostate cancer, and they could be attributed to other causes such as urinary tract infections, urinary stones or even prostate enlargement.

What is Advanced Prostate Cancer?

Advanced prostate cancer, also referred to as stage 4, is characterised by its spread beyond the prostate gland. This stage is marked by cancer reaching the pelvic lymph nodes, obstructing the ureters—the tubes connecting the kidneys to the bladder—or spreading to more distant areas such as the bladder, rectum, bones, or distant lymph nodes.

In stage 4A, the cancer may be present in one or both sides of the prostate and could have extended to nearby organs like the seminal vesicles, rectum, or pelvic wall. Stage 4B indicates that the cancer has migrated to remote parts of the body, often affecting the bones or distant lymph nodes.

What is the Difference Between Prostate Cancer and Advanced Prostate Cancer?

Symptoms of Advanced Prostate Cancer

Symptoms of advanced prostate cancer are an intensification of the usual signs associated with earlier stages of the disease, potentially signalling a more serious progression. As prostate cancer develops, the gland, situated near the urinary tract, often impacts urinary functions first.

Common symptoms include:

• A weak or inconsistent urine flow, making it challenging to start or maintain urination.
• An urgent need to urinate, which may become more frequent, especially during nighttime hours.
• Difficulty fully emptying the bladder, which can leave a sensation of residual urine.
• Pain or discomfort during urination, with possible signs of blood in the urine or semen.
• Persistent pain located in the back, hips, or pelvic area, which could be a sign of the cancer spreading to the bones.
• Systemic symptoms like unexplained fatigue, rapid heartbeat, dizziness, and pallor due to anaemia.

However, some of these symptoms may overlap with common issues like benign prostatic hyperplasia (enlarged prostate), making them easy to overlook.

Can Advanced Prostate Cancer Go Undetected?

Most of the time, prostate cancer develops at a slow rate, so there may not be any symptoms for years. This is especially so in the early stages and occasionally even in the advanced stages. However, if it is aggressive and has progressed to advanced or stage 3 or 4 prostate cancer, it can spread quickly to other areas such as the lungs, liver, lymph glands or bones.

Advanced prostate cancer may cause the following problems:

• Difficulty urinating
• Lesser force in the stream of urine
• Blood in the urine
• Blood in the semen
• Experiencing pain in the bones
• Weight loss without making an effort to do so
• Erectile dysfunction

This is why it is vital for men in Singapore, particularly those aged 50 and older, to take preventive measures. And those who face these signs and symptoms are encouraged to make an appointment with a trustworthy cancer doctor for a cancer screening or diagnosis.

Detect And Treat Prostate Cancer Early With OncoCare

If you are experiencing any of the symptoms associated with prostate cancer, it is crucial to speak to an experienced cancer specialist in Singapore as soon as possible. Although prostate cancer is one of the most common cancers in men, it can be treated if detected early.

At OncoCare, we offer a comprehensive diagnosis and work-up for all types of cancers, and our team of specialists will provide you with the necessary care. Our integrated facility allows us to screen and treat cancer patients to give you the chance to get back to your life as soon as possible. We have clinics located throughout the country, so you don’t have to travel far for appropriate care. Make an appointment at one of our centrally located clinics now, and let us help you detect and treat prostate cancer before it becomes a bigger problem.

“Expert knowledge means better care for cancer”

Written by:

Dr Tay Miah Hiang

MBBS (Singapore)

M.Med (Singapore)

MRCP (United Kingdom)

FAMS (Medical Oncology)