Prostate cancer develops when malignant cells form in the tissues of the prostate, a gland of the male reproductivesystem located below the bladder and in front of the rectum. The prostate surrounds part of the urethra and produces fluid that forms part of semen.[1]
Most prostate cancers are adenocarcinomas. Prostate cancer is more common in older men and often grows slowly however, some prostate cancers can be aggressive and spread to other parts of the body.[1,2]
Global Impact
Prostate cancer is the second most commonly diagnosed cancer among men and the fourth most commonly diagnosed cancer overall worldwide. In 2024, more than 1.5 million new cases of prostate cancer were diagnosed globally, representing almost 8% of the total global cancer burden.[3]
Approximately 420,000 people died from prostate cancer worldwide in 2024. The incidence and mortality of prostate cancer vary considerably across countries and regions.[3]
Impact in India
Prostate cancer is an important cancer among Indian men, although its incidence is lower than that reported in many high-income countries. According to IARC GLOBOCAN 2022 estimates, prostate cancer was among the commonly diagnosed cancers in Indian men.[4]
The burden of prostate cancer is expected to become increasingly important as populations age and life expectancy increases. Globally, IARC has highlighted that demographic changes are expected to contribute substantially to a future increase in prostate cancer cases, including in low- and middle-income countries.[5]
According to the NCRP, approximately 41,532 prostate cancer cases were projected in India in 2020, increasing to about 47,068 cases by 2025.[6]
Signs and Symptoms
Early-stage prostate cancer usually does not cause noticeable symptoms. Symptoms are more likely to occur when the disease becomes locally advanced or affects surrounding structures.[1]
Common signs and symptoms may include:
- Difficulty starting urination
- Frequent urination, particularly at night
- Difficulty emptying the bladder completely
- Weak or interrupted urine flow
- Blood in the urine or semen
- Persistent pain in the back, hips or pelvis.[1,2]
These symptoms may also occur due to non-cancerous prostate conditions such as benign prostatic hyperplasia (BPH). Appropriate medical evaluation is therefore required to determine their cause.[2]
Treatment Modalities
Treatment of prostate cancer depends on the stage and grade of the cancer, PSA level, age, overall health and whether the cancer has spread to other parts of the body. Some prostate cancers grow slowly and may not require immediate treatment.[1]
i. Active Surveillance and Watchful Waiting: Active surveillance involves closely monitoring prostate cancer without immediately starting treatment. Regular examinations and tests are performed to identify signs that the cancer is progressing. Watchful waiting may be considered when immediate treatment is unlikely to provide significant benefit and focuses on treating symptoms if they develop.[1]
ii. Surgery: Surgery may be used for cancer that is confined to the prostate. Radical prostatectomy involves removal of the prostate gland, surrounding tissue and seminal vesicles. Nearby lymph nodes may also be removed in selected patients.[1]
iii. Radiation Therapy: Radiation therapy uses high-energy radiation to destroy cancer cells. Both external radiation therapy and internal radiation therapy (brachytherapy) may be used to treat prostate cancer. Radiopharmaceutical therapy may also be used in selected advanced cancers.[1]
iv. Hormone Therapy: Hormone therapy, also known as androgen deprivation therapy (ADT), reduces the production or blocks the action of male hormones such as testosterone that can stimulate prostate cancer growth. It is particularly important in the treatment of advanced or metastatic prostate cancer and may also be combined with radiation therapy in selected patients.[1]
v. Chemotherapy: Chemotherapy uses medicines to kill or control rapidly dividing cancer cells. It may be used particularly for advanced prostate cancer and can be combined with hormone therapy in some patients.[1]
vi. Targeted Therapy and Immunotherapy: Targeted therapies may be used for selected prostate cancers with particular molecular or genetic alterations, including some cancers with changes in genes involved in DNA repair. Immunotherapy may also be considered for selected patients with advanced disease.[1]
Early Detection
Prostate cancer may be investigated using a prostate-specific antigen (PSA) blood test and digital rectal examination, followed by additional investigations when required. An elevated PSA level does not necessarily indicate cancer because PSA can also increase due to non-cancerous prostate conditions.[2]
Screening for prostate cancer involves a balance between potential benefits and harms. Some prostate cancers detected through screening grow so slowly that they would never have caused symptoms or threatened a person's life, leading to the possibility of overdiagnosis and overtreatment.[7]
References
- National Cancer Institute. Prostate cancer treatment (PDQ®)–patient version. Bethesda (MD): National Cancer Institute. Available from: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq
- National Cancer Institute. Understanding prostate changes. Bethesda (MD): National Cancer Institute; 2024 May 8. Available from: https://www.cancer.gov/types/prostate/understanding-prostate-changes
- International Agency for Research on Cancer. Prostate cancer [Internet]. Lyon: International Agency for Research on Cancer; 2026. Available from: https://www.iarc.who.int/cancer-type/prostate-cancer/
- International Agency for Research on Cancer. Global Cancer Observatory: India fact sheet. GLOBOCAN 2. Lyon: International Agency for Research on Cancer; 2024. Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/356-india-fact-sheet.pdf
- International Agency for Research on Cancer. The Lancet Commission on prostate cancer: planning for the surge in cases. Lyon: International Agency for Research on Cancer; 2024 Apr 5. Available from: https://www.iarc.who.int/news-events/the-lancet-commission-on-prostate-cancer-planning-for-the-surge-in-cases/
- Indian Council of Medical Research-National Centre for Disease Informatics and Research (ICMR-NCDIR). Report of National Cancer Registry Programme 2020. Bengaluru: ICMR-NCDIR; 2020. Available from: https://www.ncdirindia.org/All_Reports/Report_2020/resources/NCRP_2020_2012_16.pdf
- National Cancer Institute. Prostate cancer screening (PDQ®)–patient version. Bethesda (MD): National Cancer Institute. Available from: https://www.cancer.gov/types/prostate/patient/prostate-screening-pdq