Doc Talk Should you screen for prostate cancer?

The disease is the most common cancer in men in Singapore, with about 1,500 new diagnoses a year

- Wong Seng Weng

Picture yourself as a senior public health administrator tasked with setting up a cancer screening programme for the country. Would you ignore the most common cancer in the population and devote resources to screening for the second most prevalent type?

Well, that is exactly what Singapore is doing for its national cancer screening programme for men. Ignoring the commonest cancer in men – that being prostate cancer – and focusing on screening for colorectal cancer, the second commonest. There is logic behind such incongruence.

Prostate cancer has, in recent years, pipped long-time chart leader colorectal cancer as the commonest cancer affecting men in Singapore, based on the statistics released from the Singapore Cancer Registry towards the end of 2023. There are about 1,500 new diagnoses of prostate cancer in Singapore every year.

Under the Healthier SG initiative, men in Singapore get free screening for colorectal cancer using a stool-testing technique (known as the faecal immunochemical test) to check for the presence of occult blood as an early sign of the presence of a malignant tumour, starting from the age of 50.

This screening test is similarly made available to women. Women are also screened for the commonest female cancer, breast cancer, through the use of regular mammography.

Screening for the commonest cancer in men, prostate cancer, on the other hand, is conspicuously missing from the national programme.

MOST COMMON, BUT NOT MOST FATAL Why are we ignoring this elephant in the room? It is because this elephant, while big, is less likely to trample over us. While prostate cancer is the commonest cancer afflicting men, it is not the most fatal. In the league table ranking cancers causing death in the local male population, prostate cancer comes in at No. 5 – behind lung, colorectal, liver and pancreatic cancers. About 250 men in Singapore die of prostate cancer every year.