Prostate Cancer in Hong Kong: Symptoms, Screening and Treatment

At its earliest stage, prostate cancer does not have any symptoms. However, as it develops, the following symptoms can gradually appear:

• Difficulty passing urine; a slow and weak stream of urine
• Blood in the urine
• Urge to urinate frequently at night
• Pain in the lower back, pelvis and hips
• Discomfort or pain while sitting
• Erectile dysfunction
• Blood in semen

Although the exact causes of prostate cancer are not fully known, a number of factors are understood to increase the risk of developing it:

• Age: Older people are at a greater risk: 6 in 10 cases are men aged 65 or above. Prostate cancer is rare in men below 50 years old, but the number of younger patients is increasing. 
• Obesity: Recent research suggests there may be a link between obesity and prostate cancer. 
• Ethnic group: Prostate cancer is more common in African-American men and Caribbean men of African descent than in Caucasian or Asian men. The reason behind this is not entirely clear.
• Family history: Having a male relative who had prostate cancer when he was young increases risks of getting prostate cancer. In addition, the research also shows that risks of developing prostate cancer may be higher if having a close female relative who developed breast cancer.

There is no proven prevention strategy but certain actions can be taken to reduce the risk, including:

• Maintain a healthy weight
• Have a healthy and balanced diet
• Exercise most days of the week
• Avoid smoking and alcohol consumption 
• Receive screening regularly after the age of 50

As early prostate cancer is asymptomatic, screening is an important step towards early diagnosis to start treatment as soon as possible to prevent progression. 

Doctors would usually screen prostate cancer by:

• PSA (prostate-specific antigen tests): PSA is a substance produced by the prostate gland. Doctors usually take blood samples. A high amount of PSA may point to prostate cancer.
• DRE (digital rectal examination): Doctors will check the size and shape of the prostate gland by inserting a gloved finger into the rectum to feel the prostate.  

Further investigations are required after screening if there is anything abnormal about the screening results. Diagnosis of prostate cancer is done by:

• Ultrasound: A small probe is inserted into the rectum. The probe uses sound waves to create a picture of your prostate gland.
• Prostate Tissue Sampling: This is done by inserting a thin needle into the prostate to collect tissue, for analysis of possible cancer cells.

According to Movember Hong Kong, part of the Movember Foundation which is the leading non-profit organization fighting to improve men’s health globally, the chance of survival beyond 5 years is 98% with early diagnosis, and the rate drops to 26% if detected late. 

In order to determine the stage of a patient’s prostate cancer, most doctors would use the TNM staging system, which helps describe different aspects of the cancer’s growth.

• Stage 1: The cancer is small and grows slowly within the prostate gland, so it is unlikely to be detected during an examination by a doctor. 
• Stage 2: Cancers are also inside the prostate but can be detected by a doctor as they are larger than stage 1 cancers.
• Stage 3: Cancers grow outside the prostate. They may have reached the seminal vesicles but not the bladder or rectum. Cancers that have developed to this stage are more likely to return after treatment.
• Stage 4: The cancer is in its most serious stage as it has spread more widely to nearby organs such as the bladder, rectum or nearby lymph nodes. While a few may be curable, most stage 4 cancers are not. With incurable cancers, treatments aim at keeping cancer controlled for as long as possible, and if possible improve the patient’s quality of life.

Treatment depends upon the type and the stage of the disease. The general treatment options for prostate cancer are:

• Surgical Intervention: The main one is radical prostatectomy, where the surgeon removes the entire prostate gland, plus some surrounding tissues and the seminal vesicles. Surgery is usually undertaken when the cancer is confined only to the prostate and has not spread beyond.
• Radiation therapy: This involves exposing the area to radiation; it can be either with x-rays or other high-energy rays to kill abnormal cells. Usually, this can be done as a step to avoid surgery, or in some cases, it can be done after surgery.
• Chemotherapy: Drugs are given to stop the unwanted growth of cells.
• Hormone Therapy: Testosterone, a male hormone, serves as the main drive for the growth of prostate cells. Therefore, hormone therapy seeks to suppress testosterone production.
• Immunotherapy: It is the use of medicines to stimulate a patient’s own immune system in order to recognize and destroy cancer cells. Immunotherapy treatments for prostate cancer are:

1. Sipuleucel-T: a cell based vaccine for men with metastatic prostate cancer resistant to hormone therapy).
2. PD-1 inhibitors: they are are “immune checkpoint inhibitors”, a class of immunotherapies that block chemical signals masking cancer cells, and activate immune cells to kill tumors. One example of PD-1 inhibitors is Pembrolizumab.

Cost of treatment in Hong Kong’s Public Sector:

For eligible persons with a HKID card, the cost for inpatient service is a $75 admission fee and $120 per day. Extra medications or other injections needed are not included.

For non-eligible persons without a HKID card, the cost for inpatient general hospital is $5,100 per day.

Beware of waiting times which can be very long in the public sector. For details, call the Hospital Authority at 2300 6555.

Cost of treatment in Hong Kong’s Private Sector:

The cost of prostate cancer treatment depends on the patient’s condition. Different stages require different surgical procedures therefore it is best to consult a doctor and discuss the options that best suit your situation. In Hong Kong, fees are also determined according to the choice of room (private, semi-private, ward), doctor fees, medication fees, and administration fees of each hospital or clinic, therefore it may vary significantly. 

A consultation in the private sector ranges from $800 to $2,000 and a cycle of chemotherapy in Hong Kong’s private sector can range from $12,000 to $25,000. Fee for radiation therapy can range from $30,000 to $150,000 but depends highly on the number of doses assigned by your doctor. These are estimates, for information only.

*All amounts are in HKD. No responsibility is accepted for any inaccuracies, errors or omissions. It is always best to call ahead to make sure the information is still up-to-date.

According to Alea, prostate cancer surgery is usually reimbursed under hospital/surgical benefits whereas chemotherapy/radiation therapies are usually reimbursed under cancer cover. Generally, high-end medical plans will reimburse cancer treatments in full without any sub-limit whereas local plans will have sub-limits. If you have any health insurance questions, contact an Alea advisor at +852 2606 2668 or hello@alea.care.

• Hong Kong Cancer Fund
• Movember Hong Kong
• Hong Kong Anti-Cancer Society
• Cancer Information Hong Kong (Chinese only)

Medical-related content was reviewed by Dr. Patricia Poon. She graduated from the University of Adelaide, South Australia in 1995. She subsequently received her Oncology training at the Queen Elizabeth Hospital in Hong Kong and became a fellow of the Royal College of Radiologists in 2002. Dr. Poon earned the Fellowship of Hong Kong College Radiologists and Fellowship of the Hong Kong Academy of Medicine (Radiology) in 2005. She also obtained a Master degree in Palliative Medicine at Cardiff University, the UK in 2010. Besides training at the Queen Elizabeth Hospital in Hong Kong, she was a Consultant Oncologist at the Hong Kong Baptist Hospital until 2014. She is currently working as a private Clinical Oncologist in Hong Kong.