Attention: Men are finding prostate cancer at a later stage. Why do people avoid simple blood tests?

Most common types of cancer in men

Prostate cancer currently tops the list as the most common cancer in men in Singapore, according to data from the Singapore Cancer Registry.

Prostate, colorectal and lung cancer were the three most commonly diagnosed cancers in men from 2018 to 2022, according to data from the registry. They accounted for 17.4%, 16.2%, and 13.4% of cancers diagnosed in men, respectively.

The data also showed that the age-standardized incidence rate for prostate cancer, which measures the frequency of new cases in a population, increased from 4 to 38.2 cases per 100,000 men over 50 years.

In response to a question from CNA, a Ministry of Health (MOH) spokesperson said the increased incidence is likely due in part to increased screening, as some prostate cancers detected through screening may remain silent throughout life if they are not screened.

“We also know that prostate cancer is more common in high-income countries,” the spokesperson said.

Although the incidence of prostate cancer has increased in parallel with the number of screenings, the data also show that the number of cases detected at an early stage has decreased significantly in recent years. This is a sign that people are testing for silent diseases only in urgent cases.

The proportion of prostate cancer patients diagnosed early decreased significantly from 63.5% from 2003 to 2007 to 51.6% from 2013 to 2017.

According to registry data on prostate cancer stage distribution from 2018 to 2022, 15% of prostate cancer cases were detected at stage 1, 29.3% at stage 2, 25.5% at stage 3, and 30.2% at stage 4.

Experts say these trends are worrying.

Despite significant advances in cancer-related medical technology and prostate cancer screening being more accessible today, fewer men are discovering prostate cancer early.

He said stigma and embarrassment about discussing men's health issues, including prostate cancer, may be why men are reluctant to get tested or talk about their symptoms. Dr Jeffrey Tuan is a senior consultant in radiation oncology at the National Cancer Center Singapore.

“Fear of cancer, side effects of treatment, and misconceptions about masculinity can all prevent men from prioritizing their health,” he added.

To find out why early detection remains a challenge, CNA interviewed 60 men aged 50 and older to explore their awareness, attitudes and experiences with prostate cancer screening.

Even though 45 respondents said they get a physical examination at least once every two years, 25 of the 60 respondents said less than half had not been screened for prostate cancer.

Screening costs and low awareness

Some people avoided getting tested due to fear or lack of symptoms, while others pointed to the cost of testing.

Prostate cancer screening is not currently covered by supplemental screening under the national health screening program known as Healthier SG Screening.

Ministry of Health said reference needed Based on Screening Test Review Committee (STRC) screening recommendations.

”The STRC recommends individual screening for prostate cancer with PSA for people at high risk of developing prostate cancer. ”

The ministry also advises individuals to discuss their risk profile with their doctor before proceeding and whether prostate cancer testing is appropriate for their individual circumstances.

”As such, prostate cancer screening is not included in 'Healthier SG Screening' and the Ministry of Health does not track its screening rates,” the spokesperson added.

Screening for other types of cancer, such as colorectal cancer, cervical cancer, and breast cancer, as well as cardiovascular disease, are also part of the program.

“MOH continues to encourage Singaporeans to register with Healthy SG and undergo regular testing and follow-up. Early detection and appropriate intervention can prevent or delay the onset of various conditions and diseases,” a ministry spokesperson said.

CNAs also revealed low knowledge about prostate cancer.

Of the 60 respondents, 31 said they had little or no knowledge about prostate cancer, and 32 of them either had no knowledge of prostate cancer screening or had very limited knowledge about prostate cancer screening.

Dr Terence Lim, senior consultant urologist at Assure Urology, said public awareness was “generally good” but that did not necessarily translate into action by men.

“Urinary symptoms are often more common in older men, and so are many of their friends, so they attribute it to aging,” he said, adding that men are generally less health conscious than women and may not feel the need to get regular check-ups.

Associate Professor Chong Yew Lam, a senior consultant in the urology department at Tan Tock Seng Hospital, said awareness of prostate cancer in the country was “slightly lower” than for breast cancer and colorectal cancer, for which screening is more established.

However, as patients become more informed and increasingly utilize online tools for guidance, she observed that men generally value their health more and are more willing to discuss complications and quality of life.

“They want to have more ownership, but they still want to have a trusted group of people nearby to bounce ideas off of, and that helps a lot of their dynamics and decision-making,” he says.