It's time we discuss something that often flies under the radar in our homes, clinics, and chatter — prostate cancer. This condition, which strikes millions of men worldwide, continues to grow in prevalence, particularly in nations like India where awareness is in infancy.
The silent intruder
Prostate cancer is a type of cancer that develops in the prostate gland, a small, walnut-shaped gland in the male reproductive system.
Prostate cancer starts in the prostate gland, which is one of the accessory gland of the male sex situated just beneath the bladder and ahead of the rectum. It has an important role along with seminal vesicle in male fertility, secreting seminal fluid that nourishes sperm and carries sperm.
What is so risky about prostate cancer is that it can go on silently, particularly during its initial stages. Most men do not have symptoms until the cancer has progressed. Indeed, some are diagnosed by chance while undergoing standard health examinations or testing for other ailments.
Identifying the symptoms
Despite early prostate cancer not having symptoms, men should note warning signs that include:
● Frequent urination, particularly at night
● Straining or inability to start or stop urination
● Weakened or interrupted stream of urine
● Painful or burning sensation on urination
● Blood in urine or semen
● Pelvic, back, or hip pain (indicative of more advanced disease)
It is noteworthy that the symptoms can also be due to benign prostatic hyperplasia (BPH) or urinary tract infection. But neglecting them or attributing them to it's "just age catching up" can lead to delayed diagnosis and treatment.
Who's at risk?
Though prostate cancer is diagnosed most frequently in men above the age of 50 years, some conditions raise the risk:
● Age: Risk becomes a lot higher after 50 years. Median age at diagnosis moved to 67 from 70 years a decade ago.
● Hereditary: >3 such cases in the same family or > 2 such cases diagnosed < 55 years have a high risk.
● Family history: 2 first-degree relatives or 1 first degree relative and > 2 second degree relative are at high risk.
● Genetic - Germline mutations such as BRCA2, HOXB13, BRCA1, CHEK2, ATM, MMR genes etc
● Race: African and Afro-Caribbean men are at higher risk, although data in Indian men is increasing
● Lifestyle: Metabolic syndrome, Alcohol, High fried food diet, red and processed meat and obesity have been linked to increased risk
Diagnosis and screening
Globally, the Prostate-Specific Antigen (PSA) blood test and Digital Rectal Examination (DRE) are the primary tools for screening. Though these are not foolproof diagnostic methods, they help identify men who may require further evaluation.
Once there is suspicion, imaging examinations such as mpMRI - multiparametric MRI, and a prostate biopsy (in which a small amount of tissue is checked for cancer cells), are employed to establish the diagnosis.
No national screening program exists in India, and routine screening is not practiced for all due to overdiagnosis concerns. Yet, for men over 50 — or 45 if there is a family history — yearly screening can be lifesaving.
Modern treatment strategies
Treatment varies by stage and grade of cancer, along with the patient's age, overall health, and personal preferences. The primary choices are:
● Active Surveillance: For low-risk cancer in older men, where active surveillance is preferred to treatment right away
● Surgery: Radical prostatectomy (removal of the prostate) is commonly performed when cancer is localized
● Radiation Therapy: External beam and internal radiation (brachytherapy) are utilized
● Hormone Therapy: Reduces testosterone levels, which prostate cancer requires for growth
● Chemotherapy and Immunotherapy: Applied in case of advanced or resistant diseases
New methods such as robotic surgery and targeted therapy are becoming increasingly popular in top Indian hospitals on par with western hospitals, providing greater precision and quick recovery.
Life after diagnosis
Prostate cancer diagnosis can be emotionally devastating. The good news is that survival rates are excellent, particularly if it is diagnosed early. In a well functioning man, early localized prostate cancer has a 5-year survival rate of more than 98%.
After treatment, some men will have problems such as incontinence or erectile dysfunction. Rehabilitation, physiotherapy, counseling, and drugs can control these problems. Support groups, increasingly available in India's cities, also offer emotional support and solidarity.
Breaking the silence
In Indian society, where discussions about men's health — particularly below-the-belt matters — remain whispered, awareness is the priority. Men need to be motivated to open up, get regular checks, and make their wellbeing a priority equally as that of their families.
Your life is important. Get tested. Speak with your physician. Live stronger.
Dr. Chandan MN - MCh Urology - Consultant Apollo Hospital Sheshadripuram, Bengaluru
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