Prostate cancer is more common in:

Overview

• The prostate is a small, walnut-sized gland found only in men, located just below the bladder and makes fluid that forms part of semen
• Prostate cancer occurs when cells in the prostate gland begin to grow in an uncontrolled way, forming a tumour
• Most prostate cancers grow slowly but some types grow quickly and can spread to other parts of the body and when detected early, prostate cancer is often highly treatable

How common is prostate cancer?

• Prostate cancer is the 2nd most common cancer in men worldwide
• In 2022, approximately 1.47 million new cases were diagnosed globally
• It accounts for 1 in 8 cancers in men across 118 countries
• In India, the incidence of prostate cancer has been rising steadily over the past three decades and accounts for nearly 60% of prostate cancer cases in south-central Asia

Who is commonly affected?

Prostate cancer is more common in:

• Men over the age of 50 — risk increases significantly with age
• Men with a close family member (father or brother) who has had prostate cancer
• Men of African or Asian descent have higher risk
• Men with inherited gene mutations such as BRCA1 or BRCA2
• Men who are overweight or eat a diet high in red meat and low in vegetables

Risk factors

• Age over 50 — DNA damage in prostate cells becomes more likely as men grow older
• Family history of prostate, breast, or ovarian cancer in close relatives
• Inherited gene mutations (e.g. BRCA1, BRCA2 or Lynch syndrome)
• Race — men of African descent face higher risk, including more aggressive forms at a younger age
• Diet high in red meat and dairy, and low in fruits and vegetables
• Obesity — may increase the risk of a more aggressive form of the disease
• Lack of regular physical activity
• Smoking — may increase the risk of dying from prostate cancer
• Exposure to certain workplace chemicals over a long period

Symptoms of prostate cancer

Most men with early-stage prostate cancer have no symptoms at all. Symptoms usually appear when the tumour grows large enough to press on the urinary tube (urethra). These may include:

• Needing to pass urine more often, especially at night
• A weak or slow flow when urinating
• Difficulty starting or stopping urination
• A feeling that the bladder has not fully emptied
• Blood in urine or in semen
• Pain or discomfort during urination or ejaculation
• Difficulty getting or maintaining an erection

Warning signs of a serious condition

• Persistent bone pain in the back, hips, or pelvis
• Unexplained weight loss or extreme, ongoing tiredness
• Swelling of the legs or feet
• Shortness of breath, dizziness, or pale skin

Diagnosis and Investigations

Routine clinical evaluation

If your doctor suspects prostate cancer, or as part of routine screening, you will be offered the following tests:

• PSA blood test: Measures the level of prostate-specific antigen (PSA) protein in the blood and a raised level may indicate cancer
• Digital rectal examination (DRE): The doctor gently feels the prostate through the back passage to check for any lumps or hard areas

Further tests

• MRI scan: Detailed imaging of the prostate to locate any abnormal areas and guide the biopsy
• Prostate biopsy: Small tissue samples are taken using a thin needle under local anaesthetic; it is the only definitive test to confirm cancer
• Bone scan or CT scan: If cancer is confirmed, these can check if cancer has spread to other parts of the body

Understanding the Gleason score

• After a biopsy, a specialist examines the tissue and gives it a score
• A number from 6 to 10 that describes how aggressive the cancer cells appear
• A lower score (6) means slow-growing cancer and a higher score (9–10) means a more aggressive type that needs prompt treatment

What to expect?

• PSA tests and MRI scans are painless
• A biopsy may cause mild discomfort and light bleeding for a few days
• Results are usually available within 1–2 weeks
• Your doctor will explain all findings and discuss next steps with you

Treatment options

The treatment recommended depends on how aggressive the cancer is, whether it has spread, your age, and your overall health. Options include:

Active surveillance (watchful waiting)

• Recommended for slow-growing, low-risk prostate cancers
• Involves regular PSA tests (every 6 months), MRI scans and repeat biopsies to monitor the cancer
• No immediate treatment is given, avoiding side effects unless the cancer progresses

Surgery

• Removal of the entire prostate gland (radical prostatectomy)
• Suitable when the cancer is confined to the prostate and the patient is generally healthy
• Newer nerve-sparing techniques aim to protect urinary and sexual function

Radiation therapy

• External beam radiation: A machine directs rays at the prostate from outside the body
• Brachytherapy: Small radioactive seeds are placed directly inside the prostate gland

Hormone therapy (androgen deprivation therapy)

• Reduces levels of the male hormone testosterone, which fuels prostate cancer growth
• Often used alongside radiation therapy or for cancers that have spread beyond the prostate

When is more aggressive treatment needed?

• Surgery or radiation is recommended when the Gleason score is 7 or above
• When the cancer has spread beyond the prostate or PSA levels are rising quickly
• Your doctor will discuss all options based on your individual situation

Lifestyle and prevention

Recommended diet

• Fruits and vegetables daily
• Whole grains (brown rice, oats, whole wheat)
• Lean proteins (fish, pulses, legumes)
• Limit red meat and processed foods
• Reduce salt and sugar intake

Exercise

• At least 150 minutes per week of moderate physical activity
• Walking, swimming, yoga, or cycling

Long-term care

• Attend regular follow-up appointments and PSA monitoring
• Take all prescribed medicines on time
• Stop smoking and limit alcohol consumption
• Discuss any new or worsening symptoms promptly with your doctor

When to contact a doctor?

• New or changing urinary symptoms
• Bone pain or unexplained weight loss
• Side effects from medicines or treatment
• Persistent sadness, anxiety, or emotional difficulty

Myths and facts

Myth 1: Prostate cancer always causes symptoms early on

Fact: Most men with early-stage prostate cancer have no symptoms. This is why regular screening for men over 50 is important.

Myth 2: Only elderly men get prostate cancer

Fact: Although more common in older men, younger men with a family history or inherited gene mutations can also develop prostate cancer. In India, cases are increasingly being seen in men under 60.

Myth 3: A raised PSA level always means cancer

Fact: PSA can be raised due to non-cancerous conditions such as prostate enlargement or infection. Further tests are always needed to confirm a diagnosis.

Myth 4: Surgery is the only treatment for prostate cancer

Fact: Many men with low-risk prostate cancer are managed with active surveillance and never need surgery or radiation. Treatment is always individualised.

Frequently asked questions (FAQs)