Author: Dr Poh

Prostate cancer is the most common cancer in men. Most prostate cancers are slow-growing but some prostate cancers are aggressive. Increasing age is the most important risk factor for developing prostate cancer. However, a small number of cases can happen to men below the age of 65.

The prostate gland and age-related changes

The prostate is located between the bladder and the penis, measuring about the size of a walnut. Its main function is to secrete prostatatic fluid, one of the components of semen. Enlargement of the prostate is called benign prostatic hyperplasia (BPH) and is common in men above the age of 50.

Benign Prostatic Hyperplasia (BPH)

BPH is not cancer and is considered part of normal age-related changes. It does not increase the risk of cancer but it could produce symptoms that can affect your quality of life.

These symptoms include

• Incomplete bladder emptying
• Nocturia, which is the need to urinate two or more times per night
• Trouble urinating
• Discomfort in the pelvic area
• Painful urination
• Blood in the semen or urine

BPH and prostate cancer have similar symptoms, so it’s sometimes hard to tell the two conditions apart. Make an appointment with your doctor if you have any signs or symptoms that worry you.

Prostate Cancer: How do you tell it apart from BPH

Prostate cancer begins when some cells in your prostate become abnormal. The abnormal cells accumulate and multiple to form a tumor that can grow to invade nearby tissue. Some abnormal cells can also spread (metastasize) to other parts of the body. Hence, prostate cancer that’s detected early has a better chance of successful treatment.

When you first have symptoms, your doctor will arrange for a Prostate-specific antigen (PSA) test. This is a blood to detect a protein your prostate gland makes which can be high when your prostate grows. It can’t tell for sure that you have BPH or prostate cancer. Your doctor may also examine your recturm with his/her finger to check if your prostate is enlarged.

If abnormalities are found and there is suspicion of possible cancer, you will need to be referred to a specialist where a biopsy can be done, which removes a sample of prostate tissue and checks it under a microscope for cancer.

Imaging such as ultrasound and MRI can be useful to assess the prostate gland.

Is there a cure?

The curative treatment for prostate cancer depends on the stage of the disease. In most cases, if there is no spread, curative treatments for prostate cancer include:

• Active surveillance or watchful waiting: Your doctor watches your symptoms or does regular DRE and/or PSA tests to check for cancer growth. Many people die with prostate cancer instead of prostate cancer. Hence no treatment is needed in some cases.
• Surgery: A procedure called a radical prostatectomy removes the prostate gland and some of the tissue around it.
• Radiation therapy: Radiation uses high-energy X-rays to destroy prostate cancer. It can be done with a radiation beam or you can get it through small radioactive pellets or seeds placed inside your prostate.
• Cryotherapy: This treatment uses intense cold to destroy prostate tissue. Freezing often damages the nerves near the prostate that control erections and can cause erectile dysfunction after treatment.
• Hormone therapy: You take medicine to block the male hormones that fuel the growth of prostate cancer.

When treated, the five-year survival rate for all stages of prostate cancer is almost 100 percent compared to men without this cancer.

How are my symptoms treated?

Symptomatic treatment for prostate cancer is similar to BPH.

Alpha-blockers such as alfuzosin (Uroxatral), doxazosin (Cardura), and tamsulosin (Flomax) relax muscles in your bladder and prostate to help you urinate more easily.

5-alpha reductase inhibitors, such as dutasteride (Avodart) and finasteride (Proscar), shrink your prostate.

How can I prevent prostate cancer?

If you’ve already been diagnosed with BPH or prostate cancer, see your doctor for regular follow-ups. Routine screening isn’t recommended for prostate cancer, you might want to get screened with a DRE or PSA test based on your age and risks. Ask your doctor if you have any questions.

Several studies have shown that there is relation between HPV and prostate cancer. As the HPV vaccine is relatively new, the preventative role of HPV vaccines in prostate cancer requires more data to validate its use and further investigation. However, the HPV vaccine has been shown to have warts and other types of cancers in men.

What we can do for you:

Click here to make an appointment.

iDOC Clinic services:

• PSA tests
• DRE examination
• HPV vaccinations
• Referrals for Prostatic biopsy
• Follow up for BPH

Erectile dysfunction ishe inability to get and keep an erection firm enough for sex. Up to 50 % of men at the age of 50 may experience erectile dysfunction.

This week we explore the many causes of erectile dysfunction and various methods to get around it.

What causes erectile dysfunction?

Having problems keeping an erection once in a while isn’t necessarily a cause for concern but if it is an ongoing issue, it can affect your self confidence and relationships. Problems keeping an erection can also be a sign of an underlying health condition that requires medical attention and a risk for heart disease.

Some of the common causes include:

• Obesity
• Smoking
• Diabetes Mellitus
• Obstructive Sleep apnea
• Chronic Kidney Disease
• Hormonal problems.
• Psychological causes such as depression and anxiety or even performance related issues.

Some medications/prior treatment can also cause erectile dysfunction:

• Blood pressure medications
• Benzodiazepines
• SSRI Antidepressants
• Alcohol
• Prostate Cancer Treatment

What is the best treatment for erectile dysfunction

Lifestyle modifications are considered first-line therapy can can have a significant impact in ED management. However, despite the benefits of behaviour modification, men presenting with ED may want the physician to help with measures that can have an immediate impact.

What is viagra?

Viagra is a PDE5 inhibitor which works by increasing blood flow to the penis. Viagra and other PDE5 inhibitors have been the mainstay of ED treatment since 1998. These medications are able to induce good effect within a short period of time and various medications have different duration of potency.

There are also different methods of dosing, for example to take a dose before intimacy or to take a tablet everyday. PDE5 inhibitors are considered very safe and effective but a doctor will need to review you medications to ensure there arent any interactions, especially with nitrates.

It is also important to take as what your doctor has prescribed. Overdosing can lead to irreversible side effects such as blindness. It is also important that you obtain your medication from a registered clinic/pharmacy. 80% of websites claiming to sell Viagra were in fact selling counterfeits.

Are there other medications other than Viagra?

Injections such as alprostadil can also help to induce erection. A small needle is used to inject the medication into the side of the penis through a small-gauge needle.

An intraurethral form is also available, consisting of a tiny pellet of drug inserted into the urethra.

Non-medical approaches

1. Vacuum constriction devices are clear plastic chambers placed over the penis, which directs blood into the penis. If an adequate erection occurs inside the chamber, the patient may slip a small constriction band off the end of the VCD and onto the base of the penis. An erection beyond 30 min is not recommended.

2. Low-Intensity extracorporeal shock wave therapy is a useful and noninvasive treatment for erectile dysfunction. This consists of low-intensity shock waves that are applied to different areas of the penis, stimulating new blood vessel growth and improving blood flow.

Seeking Medical Advice

If you’re concerned about erectile dysfunction, speak to your doctor. Psychosexual counselling can sometimes play a huge difference. Treating an underlying condition is enough to reverse erectile dysfunction and given how common it is, there is no need to be embarrassed to seek professional advice. Lifestyle modifications, medications or other direct treatments might be needed. This is available through our telemedicine service.