Prostate and Erectile Dysfunction Treatment in Singapore

Treatment planning for localised and advanced prostate cancer depends on clinical stage, grade, PSA kinetics, imaging, comorbidity and patient preference. In Singapore, commonly used options include active surveillance, radical prostatectomy, radiotherapy with or without androgen deprivation therapy, and systemic therapy for metastatic disease. Selection is guided by structured risk stratification and multidisciplinary input to balance oncological control with urinary, bowel and sexual function outcomes. For patients experiencing post-treatment sexual dysfunction or unrelated vasculogenic causes, evidence-based erectile dysfunction treatment in Singapore spans oral pharmacotherapy, device-based therapies, injections and implant surgery, with psychological care where indicated.

Localised Disease: Surveillance, Surgery and Radiation

Very-low and low-risk cancers may be suitable for active surveillance with predefined PSA, MRI and biopsy intervals to defer definitive therapy until progression. For fit patients electing definitive local control, radical prostatectomy, including robotic-assisted approaches, is used for localised and some locally advanced tumours, with the intent of complete gland removal and pathological staging. Institutions in Singapore perform robotic radical prostatectomy using laparoscopic ports to minimise blood loss and length of stay while enabling nerve-sparing where oncologically safe.

External beam radiotherapy and brachytherapy are alternatives to surgery for organ-confined disease. Contemporary external beam techniques, often intensity-modulated with image guidance, allow conformal dosing to reduce rectal and bladder exposure. Risk-adapted courses of androgen deprivation therapy are sometimes combined with radiation in unfavourable-intermediate or high-risk settings to improve biochemical control.

Locally Advanced and Node

For locally advanced prostate cancer, combined-modality management is commonly considered. Radiotherapy to the prostate and pelvis with a defined period of androgen deprivation therapy is a standard approach supported by long-term control data. Surgical options may still be discussed in selected cases within a multimodal plan that anticipates adjuvant or salvage treatments based on margins, nodal status and postoperative PSA trend.

Metastatic and Recurrent Disease

Androgen deprivation therapy remains the systemic backbone when the disease is metastatic or biochemically recurrent with systemic risk. It can be delivered by luteinising hormone-releasing hormone analogues or antagonists, and is frequently combined with other systemic agents according to current oncology protocols. For selected patients with low-volume metastatic disease, prostate-directed radiotherapy may be considered as part of multidisciplinary care.

Focal and Investigational Options

High-intensity focused ultrasound and other focal modalities are under evaluation. In Singapore, the Ministry of Health currently directs that HIFU for prostate cancer be provided only in clinical trial settings with appropriate ethics approval and publication of outcomes, reflecting the need for robust evidence before routine adoption. Patients enquiring about focal therapies should be counselled regarding investigational status and eligibility for trials.

Adverse Effects and Functional Outcomes

Across radical prostatectomy and radiotherapy, adverse effects can include urinary incontinence, erectile dysfunction and, with radiation, bowel symptoms. Rates vary with technique, baseline function, comorbidity and use of nerve-sparing or dose-modulation methods. Early pelvic floor rehabilitation, optimisation of cardiovascular risk factors and coordinated survivorship follow-up are integral to mitigating long-term morbidity.

Erectile Dysfunction: Assessment and First Line Interventions

Erectile dysfunction may precede prostate cancer diagnosis due to shared vascular risk factors, or it may occur after treatment owing to neurovascular bundle trauma, cavernous nerve neuropraxia, arterial insufficiency or veno-occlusive dysfunction. Initial assessment documents onset, severity, medication use and psychosocial contributors. First-line management typically includes lifestyle modification and, provided they are not contraindicated, oral phosphodiesterase-5 inhibitors. Where hypogonadism coexists, testosterone can be considered with appropriate oncology input in cancer survivors.

Device-Based and Procedural Therapies

For vasculogenic erectile dysfunction unresponsive to oral therapy, vacuum erection devices offer a noninvasive option to generate tumescence with a constriction ring to maintain rigidity. Intracavernosal injections provide on-demand pharmacological erection independent of neural pathways and are used with structured dose titration and training. Low-intensity extracorporeal shockwave therapy has been implemented locally for selected vasculogenic erectile dysfunction cohorts; protocols typically involve weekly sessions over several weeks with the aim of promoting neovascularisation, although candidacy and expected effect size should be discussed.

Penile Prosthesis For Refractory Cases

For patients with severe erectile dysfunction who have not responded to medical or device therapies, penile prosthesis implantation is a definitive option that enables on-demand rigidity. Device selection, antibiotic prophylaxis, and counselling regarding mechanical longevity and revision rates are part of preoperative planning. Post-prostatectomy patients can be considered after stabilisation of urinary continence and completion of oncological therapy.

Coordinating Cancer Control and Sexual Function Care

The goal of prostate cancer treatment is durable oncological control with the lowest achievable functional burden. Integrating sexual health early in the pathway is associated with better outcomes. Patients should be advised that erectile dysfunction treatment in Singapore spans pharmacological, device-based and surgical options in a stepwise manner, and that expectations differ after radical prostatectomy versus radiotherapy. Shared decision-making that includes cancer control probabilities, functional risk and available rehabilitation improves satisfaction and reduces decisional regret.

When to Seek Evaluation

Men with LUTS, haematospermia, bone pain or a significant family history should discuss prostate assessment, recognising that Singapore does not operate a population screening programme; investigation is recommended when symptoms or risk factors are present. New erectile dysfunction, especially with cardiovascular risk factors, warrants evaluation because it can be an early marker of endothelial disease and may coexist with prostate pathology.

Conclusion

Prostate cancer treatment is risk-stratified and multidisciplinary, drawing on surgery, radiation and systemic therapy according to disease extent and patient factors. Parallel management of sexual function uses an algorithm that progresses from oral agents and devices to injections and prosthesis for refractory cases. Patients considering prostate cancer treatment or seeking erectile dysfunction treatment in Singapore should expect a detailed consultation on benefits, risks and expected functional outcomes based on current local practice and evidence.

For a consultation on diagnostic evaluation, prostate cancer treatment planning, or evidence-based erectile dysfunction treatment in Singapore, contact the National University Hospital (NUH).