Singapore's smarter approach to prostate cancer: early screening and less invasive care

Most visitors to Singapore come away talking about the shopping districts, the hawker stalls, the trains that run on time. I arrived as a journalist curious about something less visible: how a city-state had built a healthcare system that actually worked for ordinary people, not just the wealthy.

That question led me to Singapore General Hospital, the flagship of SingHealth, the country's largest public healthcare network. What struck me was not the sophistication of the equipment—though the hospital certainly has that in abundance. It was the architecture underneath: a system where government subsidies and public polyclinics made advanced care accessible to citizens across income levels. Patients could enter through subsidized public care, choose private specialists if they preferred, or arrive through emergency departments when urgency demanded it. The hospital itself, the oldest in Singapore, houses 46 specialties and subspecialties, woven into a network reaching across the island.

Standing in that hospital, I thought about home. The Philippines has excellent doctors, brilliant specialists, dedicated healthcare workers. But access remains the fracture line. For most Filipino families, the question is not "What is the best treatment?" but "Can we afford it?" That gap between what medicine can do and what people can actually access is what makes Singapore's model worth examining—not because the hospitals are advanced, but because the system behind them is designed to let people benefit from those advances.

The conference I attended focused on urology, a field that touches ordinary concerns as men age: prostate problems, urinary difficulties, and most seriously, prostate cancer. Associate Professor Dr. John Yuen Shyi Peng, head of SGH's Department of Urology, walked through how his team was rethinking the entire patient journey—making it less invasive, less painful, faster.

Start with diagnosis. Using prostate MRI and PSMA imaging, SGH is testing whether carefully selected patients with highly indicative scans can skip the biopsy entirely and move directly to surgery. In an initial group of 15 patients who met strict criteria, all were confirmed to have cancer after surgery. It is still highly selective, Dr. Yuen emphasized, but for the right patient, avoiding a biopsy means avoiding an invasive procedure, its complications, and its cost. For those who do need a biopsy, the department has shifted technique: instead of passing the needle through the rectum—bacteria-rich and infection-prone—doctors now enter through the skin between the scrotum and anus. The transperineal approach substantially reduces infection risk.

Then surgery itself. SGH performs robotic prostatectomy through an extraperitoneal approach, working outside the abdominal cavity rather than disturbing the intestines. Patients can eat, walk, and recover more comfortably sooner. The surgeons have also reduced incisions: instead of the five or six small wounds typical in robotic surgery, suitable patients may need only one to three, depending on complexity. And here is the part that seemed almost impossible: some patients go home the same day. Dr. Yuen shared data showing that about 90 percent of patients assessed under SGH's 23-hour discharge pathway meet criteria for safe early release—able to eat, drink, walk independently, with pain controlled and no significant bleeding. International patients, including those from the Philippines, typically remain in Singapore for about 10 days, recovering at a hotel with family while the catheter remains in place. SGH can then coordinate catheter removal and follow-up care with doctors back home.

But perhaps the most important lesson has nothing to do with robots or imaging. Prostate cancer is often silent in its early stages. By the time symptoms appear—urinary difficulties, other warning signs—the disease may already be advanced. That is why Dr. Yuen stresses PSA screening, a simple blood test that can guide doctors on whether further investigation is needed and how frequently a man should be monitored. International guidelines generally recommend that men discuss PSA screening with their doctors from around age 45, or earlier and more frequently if they have risk factors like strong family history. For many Filipino men, the conversation itself is the barrier. Some are uncomfortable discussing changes in their bodies. Others assume that getting up several times at night to urinate is simply what aging looks like. But that assumption can be costly. A PSA test is simple. The harder part is making the appointment.

What impressed me most about SGH's urology program was not the technology alone, but the thinking behind it. The department combines patient care with research, education, and collaboration—sharing expertise with doctors and institutions beyond Singapore's borders. During the conference, I met two Filipino physicians: Dr. Diosdado C. Limjoco of St. Luke's Medical Center–Quezon City and Dr. Ana Melissa Cabungcal of Makati Medical Center. Their presence underscored a larger truth: medical knowledge does not stop at borders. Dr. Limjoco spoke about how such conferences strengthen collaboration in managing complex cases, allowing Filipino doctors to refer patients to specialized centers like SGH while maintaining continuity in treatment. That willingness to share knowledge across borders, to learn from each other, is as important as any innovation. For prostate cancer, the message is straightforward: know your risk, talk to your doctor, ask about PSA screening when appropriate, and do not dismiss changes in urinary health as normal aging. Early attention can make all the difference.