Singapore doctors urged to raise awareness of prostate disease

Medical Tribune August 2008 SFI
David Brill

Many Singaporean men are suffering prostate problems in silence, according to a recent survey.

While 75 percent of those questioned had experienced symptoms of benign prostatic hyperplasia (BPH), just 56 percent had visited their doctor.

The majority of those who had symptoms had been suffering for at least 6 months, and half of those who did seek medical attention reported that urinary issues had begun to get in the way of their lives.

Nearly all of the men in the study felt that BPH was simply a natural part of growing old rather than a medical condition.

The president of the Singapore Urological Association (SUA) called for more to be done to raise public awareness of prostate disease.

“It is really a shame that here is a disease [BPH] that is eminently treatable, but many men are unaware that this is actually a disease and therefore do not seek treatment,” said Associate Professor Kesavan Esuvaranathan, who is also the clinical director of the National University Hospital Urology Centre.

“In the same way that elderly people will not go to the doctor and say ‘my hair is whitening’, they also don’t go to their doctor and say ‘I’m having difficulty with urination’, because all their buddies are having the same problems.”

GPs should ask their patients about prostate issues but be careful with their choice of approach, he said.

“The question they should not ask is ‘do you have a problem with urination?’ because invariably patients will say no.

“The questions they have to ask are: ‘Do you wake up at night to visit the bathroom? Do you have to wait a long time to finish? Are you bothered by these symptoms?’”

Once this type of dialogue is initiated and problems identified, doctors can go further and begin to provide treatment, Esuvaranathan said, adding that private healthcare doctors tend not to ask these questions so patients are less forthcoming with seeking advice.

Besides BPH, he noted that the incidence of prostate cancer has grown “exponentially” in Singapore and is now in the top ten leading causes of death from cancer.

The survey, which involved 480 Singaporean men, was conducted in July as part of Prostate Awareness Month – a national campaign by the SUA to educate the public about prostate disease and encourage people to seek early treatment.

Over the course of the month various hospitals offered screening to men aged 50 to 75 at a subsidized cost of $8. The campaign began with a free public forum at Kallang Community Centre, which was attended by 920 men.

The most commonly-reported concerns about BPH were physical discomfort caused by the inability to urinate properly, tiredness due to a lack of normal sleep, and the inconvenience and impact that the condition had on relationships and family life.

Treatment options for BPH include medications such as alpha blockers and 5-alpha reductase inhibitors, and surgery. For prostate cancer radiation therapy, hormone therapy, chemotherapy and surgery can be used, depending on the case.