SINGAPORE: A man who was the first among four brothers to start sexually abusing their younger sister was on Tuesday (May 21) sentenced to 18 years in jail and 24 strokes of the cane.

Justice Mavis Chionh decided on a longer jail term than the 16 years proposed by the prosecution and defence, which she said was not commensurate with his crime.

The man, now 22, is the second-oldest of the four brothers. The assailants cannot be named in order to protect the identity of the victim.

He pleaded guilty to three charges of aggravated rape, which carries a minimum penalty of eight years in jail and 12 strokes of the cane.

Another 16 charges of aggravated rape and aggravated sexual assault were considered in sentencing.

The girl was sexually abused by her four brothers from 2018 to 2022, when she was eight to 12 years old.

The brother convicted on Tuesday was the first to start sexually abusing her in 2018. His last assault on her happened only a week before he was arrested in February 2022.

He said he would rather sexually abuse his sister than meet his urges with a girlfriend due to his past experience of being “heartbroken”, said Deputy Public Prosecutor M Kayal Pillay.

The man, who was 16 to 20 at the time of the offences, also deliberately chose to assault the victim over her two younger sisters because of her body, said the prosecutor.

The family of four brothers and three sisters lived with their parents. The siblings slept in separate boys’ and girls’ rooms, while their parents slept in the master bedroom.

The man assaulted his sister in all three bedrooms. On some occasions he did so even when the two other sisters were asleep beside her.

The victim physically resisted his advances and he knew that she did not consent to the sexual activity, the prosecutor said.

The abuse came to light when the victim entered secondary school and found the courage to tell school staff what happened.

She subsequently showed trauma symptoms such as hypervigilance and frequent strong feelings of disgust, fear and sadness.

She was referred for trauma-focused cognitive behavioural therapy and showed significant improvement after her therapy sessions.

This is the last brother to be convicted in the case. The oldest brother was sentenced on Monday, and the two youngest brothers are awaiting reports on their suitability for reformative training.

Arguing for a sentence of 16 years’ jail and 24 strokes of the cane, Ms Pillay said that the offender admitted he would have continued the sexual abuse if it had not been reported.

“The accused’s perverse acts have left a stain on the victim’s tender years when she should have been concerned with no more than her school assignments and peer-aged friendships,” said the prosecution.

“Instead, she is left with a quagmire of guilt and trauma to navigate.”

In mitigation, defence lawyer Stephania Wong of Rajah & Tann read out an extract of a letter from her client, in which he apologised to his family and the victim.

The man said he had “ruined” the victim’s life and “traumatised” her when he was “supposed to take care of her”. He hoped for a chance to apologise in person and promised to be “more responsible”.

Ms Wong also pointed to the offender’s young age of 16 to 20 during the abuse.

She argued that he was exposed to inappropriate sexualised behaviour and pornographic material as a teen and did not receive proper guidance from an adult, which contributed to his offences.

But Justice Chionh said the sentence proposed by both the prosecution and defence was not enough to reflect the overall criminality of the man’s conduct, and not in line with past cases.

She said that while he faced fewer charges than his oldest brother – who had 42 charges and was sentenced to 20 years’ jail and caning – the bulk of his offences involved “actual consummation” of rape.

She highlighted the man’s abuse of the trust and responsibility placed in him as the victim’s older brother, and the extended period of five years during which he “sexually terrorised” her.

She also noted the severe harm the victim suffered, including her current separation from her younger sisters and parents “through no fault of her own”.

Justice Chionh said the offender would still be quite young when his sentence was completed, and expressed hope he would rehabilitate himself as he had said he wanted to.

Reiterating her call for the victim to take courage and forge ahead, she added that the fact that the girl’s psychologist said she had shown improvement was a testament to her fortitude.

The judge also expressed hope that the girl’s family would rally around to show her love, support and encouragement.

SINGAPORE: Prostate cancer patients undergoing radiation treatment can now experience fewer side effects such as bleeding, with the introduction of an innovative procedure that minimises radiation exposure to the rectum.

This new rectal spacer technique has been used by doctors at the National University Hospital (NUH) to enhance treatment outcomes and improve the quality of life for such patients.

A rectal spacer acts as a physical barrier to increase the distance between the prostate and the rectum, in order to protect the rectum from unwanted exposure to radiation.

This intervention reduces the likelihood of long-term, debilitating side effects that can lead to frequent hospitalisation.

PROTECTIVE BARRIER AGAINST RADIATION EXPOSURE

Prostate cancer is the most common cancer affecting men in Singapore, and usually occurs in men over the age of 50.

According to the Singapore Cancer Registry Annual Report 2021, it made up nearly 17 per cent of cancer diagnoses among males, with 6,912 cases reported from 2017 to 2021.

Since May 2022, 150 patients have benefitted from the minimally invasive outpatient procedure, said the National University Health System (NUHS) in a press release on Monday (May 20).

The 15-minute procedure, performed under general anaesthesia, involves the implantation of a gel-like substance that acts as a barrier between the prostate and rectum during radiation treatment.

It has shown promise with no major adverse reactions among the treated patients, NUHS added.

For patients undergoing external beam radiation therapy, the rectal spacer technique reduces the risk of radiation-induced damage leading to complications like rectal bleeding.

Such therapy involves beams of radiation from a machine being focused on a patient’s prostate. Patients undergo treatment five days a week, for about four to eight weeks.

“Reducing the risk of radiation-induced side effects is a priority for us, as up to 10 per cent of patients may experience clinically significant side effects that last beyond three months following the completion of radiation therapy,” said Adjunct Associate Professor Jeremy Tey, senior consultant in the Department of Radiation Oncology at the National University Cancer Institute, Singapore (NCIS)

“A small proportion of patients may have rectal bleeding so severe that they require blood transfusions at the hospital. It’s important that we continuously look at ways to improve patient outcomes and quality of life,” he added.

REDUCING DAMAGE TO NORMAL TISSUES

The challenge with radiation therapy for prostate cancer patients involves targeting the cancer effectively while minimising damage to surrounding tissues, said doctors.

“Radiation is one of the very established treatments now for prostate cancer, and part of the radiation involves targeting the prostate. Despite advances in radiation, we can’t make that radiation zone perfect, and the rectum sits just behind the prostate,” said Dr Arshvin Kesavan, associate consultant at the NUH’s Department of Urology.

“The way radiation works is … it causes cancer cell death. But of course, it’s not so discriminatory and it can harm normal tissue as well. If that tissue is in that radiation zone, it can get affected.”

NUH urologists use biodegradable rectal spacers that are absorbed by a patient’s body after a period of time. These are approved by the United States Food and Drug Administration and Singapore’s Health Sciences Authority.

The procedure is tailored to each patient’s specific situation. It also takes into account the size, location and invasiveness of the tumour, as well as individual anatomical factors.

The technique has changed the way that prostate cancer patients are now looking at radiation, Dr Arshvin told CNA’s Singapore Tonight on Monday.

“Before this, they’d be very concerned about these types of side effects. But now that they know we have this protection, radiation is becoming a lot more accessible to people and more acceptable to people.”

ENHANCING QUALITY OF LIFE FOR PATIENTS

When the rectum is exposed to radiation without a protective gel in place, about 20 to 30 per cent of patients could suffer from side effects, noted Dr Arshvin.

“That could be as mild as maybe going to the toilet more frequently. But it can be as severe as developing ulcers which bleed, and when this problem happens, there’s no good treatment,” he added.

“So it can be a recurring issue even years after radiation has been completed.”

Out of the 150 patients who benefitted from the procedure, none had serious rectal ulcers. The number of patients who experienced minor symptoms after the gel was in place also dropped, from 30 per cent to 4 per cent, Dr Arshvin said.

Patients with locally advanced prostate cancer such as cancer that has invaded the wall of the rectum; those with pre-existing urinary retention; and others at high risk under general anaesthesia may not be offered the procedure.

Among those who have gone through the procedure is Mr David Peter Dowdell, who was diagnosed with prostate cancer last year.

The 63-year-old did not hesitate when offered the option, and went for it last September.

Nearly a month later, the director in a technology firm started his radiation therapy and has had 41 such sessions at the NCIS over two months.

“Medically sometimes, you can’t have this gel,” said Mr Dowdell, who experienced no side effects from his radiation.

“But for those who can, it shouldn’t be an option. It should be part of the process.”

The NUH team is providing training of this new procedure to surgeons at other public hospitals.

Associate Professor Edmund Chiong, head and senior consultant at NUH’s Department of Urology, said: “By adopting this technique, we are not just aiming to treat prostate cancer.

“We are also focused on enhancing the comfort and improving the quality of life for our patients during and after treatment.”