Fear of cancer, treatment side effects and misconceptions about masculinity may prevent men from prioritising their health, one doctor said.
When Mr Chiu Ku Ee went for his annual health screening 12 years ago, his doctor advised him to include a prostate-specific antigen (PSA) blood test as part of his check-up.
He did not think much about it, even when the results showed that his reading was “elevated just above the threshold”, the 69-year-old said.
But after being referred for a biopsy when his PSA level rose again, what he had once thought unimaginable came true.
Sometime in 2013, Mr Chiu was diagnosed with prostate cancer.
“I went totally blank and could not comprehend what the doctor was saying anymore,” he said.
“It was a rollercoaster ride after that, both psychologically and emotionally.”
His immediate concerns were how he would continue financially supporting his siblings and elderly mother, and which of the “too many” treatment options he should choose.
After seeing three different doctors who gave him different treatment choices on the best way to manage his stage one diagnosis, Mr Chiu decided to choose active surveillance.
This meant that he would monitor his cancer closely instead of starting treatment.
He waited seven years before he started treatment.
In these seven years, Mr Chiu took it upon himself to gather as much information as he could about prostate cancer.
He spoke to fellow survivors, doctors and read up on information available online, before deciding to undergo stereotactic body radiation therapy in 2021.
He is currently in remission for prostate cancer.
Mr Chiu was one of the lucky ones who managed to get the cancer diagnosed and treated when it was still in the early stages.
While his is a case of picking the right treatment path among the myriad of choices, for many others, the diagnosis of prostate cancer would come far too late and with fewer life-saving options available to them.
MOST COMMON TYPE OF CANCER AMONG MEN
Today, prostate cancer now tops the list as the most common cancer among men in Singapore, data from the Singapore Cancer Registry showed.
From 2018 to 2022, prostate, colorectal and lung cancers were the three most common cancers diagnosed in males, according to the registry’s data. They accounted for 17.4 per cent, 16.2 per cent and 13.4 per cent of cancers diagnosed in males respectively.
The data also showed that prostate cancer’s age-standardised incidence rate, which measures how common new cases of a disease are in a population, had increased from 4 to 38.2 cases per 100,000 men over a five-decade period.
Responding to queries from CNA, a Ministry of Health (MOH) spokesperson said the rise in incidence rate is likely to be partly due to increased screening, as some screen-detected prostate cancers may have remained silent throughout the lifetime of an individual in the absence of screening.
“Prostate cancer is also known to be more common in high-income countries,” said the spokesperson.
While prostate cancer rates rose in tandem with the number of screenings, the data also shows that the number of cases detected at an early stage fell more drastically in recent years – a sign that people are only testing for the silent disease when it becomes urgent.
The proportion of prostate cancer patients diagnosed at an early stage fell significantly from 63.5 per cent in the 2003 to 2007 period to 51.6 per cent in the 2013 to 2017 time span.
According to the registry’s data on stage distribution of prostate cancer from 2018 to 2022, 15 per cent of prostate cancer cases were discovered in stage one, 29.3 per cent in stage two, 25.5 per cent in stage three and 30.2 per cent in stage four.
These trends are concerning, experts said.
Despite large advances in cancer-related medical technology and the greater availability of prostate cancer screening today, fewer men are catching the disease early.
Stigma and embarrassment about discussing men’s health issues, including prostate cancer, could be why men are reticent about going for tests or talking about their symptoms, said Dr Jeffrey Tuan, a senior consultant of radiation oncology at the National Cancer Centre Singapore.
“Fear of cancer, treatment side effects, and misconceptions about masculinity may prevent men from prioritising their health,” he added.
To uncover the reasons why early detection remains a challenge, CNA spoke to 60 men aged 50 and above to find out their awareness, attitudes and experiences with prostate cancer screening.
Less than half, or 25 respondents out of the 60, have not been for a prostate cancer screening, even though 45 respondents said they go for a health screening at least once every two years.
SCREENING COST, LOW AWARENESS
While some avoided going for tests due to fear or a lack of symptoms, others pointed to the cost of screening.
Prostate cancer screening is currently not a subsidised screening under the national health screening programme, known as Healthier SG Screening.
MOH said it takes reference from the Screening Test Review Committee’s (STRC) recommendations for screening.
“STRC recommends that screening for prostate cancer with the PSA be done on an individual level for those who have a high risk of getting prostate cancer.”
The ministry also advises individuals to discuss their risk profile with their doctor and whether prostate cancer screening is appropriate for their individual circumstances before proceeding.
“As such, prostate cancer screening is not included in Healthier SG Screening, and MOH does not track its screening rate,” the spokesperson added.
Screening for other types of cancers – colorectal, cervical and breast – as well as cardiovascular diseases, are part of the programme.
“MOH continually encourages Singapore Citizens to enrol with Healthier SG and go for regular screenings and follow-ups. With early detection and appropriate intervention, we can prevent or delay the onset of various conditions and diseases,” the ministry’s spokesperson said.
CNA also found that knowledge of prostate cancer was low.
Of the 60 respondents, 31 said they had little to no knowledge on prostate cancer, while 32 of them never knew prostate cancer screening existed or had very limited knowledge about it.
Dr Terrence Lim, a senior consultant urologist at Assure Urology, said that while public awareness is “generally good”, that does not necessarily translate to men taking action.
“A lot of times, urinary symptoms are common in older men and many of their friends have that. So they attribute it to aging,” he said, adding that men are generally less health conscious than women and may not see the need to go for regular screenings.
Assoc Prof Chong Yew Lam, a senior consultant at the department of urology at Tan Tock Seng Hospital, said awareness of prostate cancer in the country is “slightly lower” compared to breast and colorectal cancer, for which screenings are relatively established.
However, as patients become more informed and increasingly turn to online tools for guidance, he has observed that in general, men are taking greater ownership of their health and are more willing to discuss complications and quality of life.
“They want to take more ownership, but still want a trusted peer nearby to bounce off ideas and that has helped the dynamics and decision making for many of them,” he said.
