Oncologists reveal who is more at risk of aggressive prostate cancer, explain why early detection is crucial
Back in 2014, Hollywood actor Ben Stiller was diagnosed with prostate cancer. Over the last few years, he tried to raise awareness about how early-detection helped save his life. Even veteran actor Robert De Niro is and former President of South Africa, Nelson Mandela, who died in 2013, was a prostate cancer survivor. Also read | Joe Biden diagnosed with 'aggressive' prostate cancer: All you need to know, from symptoms to cause
Prostate cancer is a type of cancer that affects the prostate gland in men. In an interview with HT Lifestyle, Dr Rama Krishna, consultant in radiation oncology at Manipal Hospitals, Vijayawada, and Dr Manohar Bhadrappa, senior consultant in chief of urology, renal transplant surgeon, and uro-oncology surgeon at Manipal Hospital Sarjapur Road, explained that prostate cancer is treatable when detected early, and patients have a wider range of options available to them.
Dr Krishna said that prostate cancer is one of the most common cancers in men, with 'one in six men affected during their lifetime': 'As per the Indian Council of Medical Research, around 47,000 new cases are diagnosed annually in India, accounting for 3 percent of all cancer cases. This number is expected to rise over the next 10 to 20 years due to increasing life expectancy and improved access to affordable healthcare.'
Dr Bhadrappa added that approximately 15 percent of prostate cancer cases fall into the high-risk category. He said, 'These are more aggressive, with a greater chance of becoming life-threatening. While some tumours remain localised and indolent, high-risk or locally advanced cancers — defined by clinical stage T2c or higher, Gleason score of 8 or more, PSA over 20 ng/mL, or over 33 percent positive biopsy samples — require aggressive treatment.'
'Age is the most significant risk factor for prostate cancer, but increasing use of screening, heightened awareness, and factors such as family history, race, and genetics also contribute to its rising incidence. Men with a close relative diagnosed at a younger age, particularly in their 50s, are at significantly higher risk,' Dr Krishna said.
He also dispelled common myths, noting that while prostate cancer is more prevalent in the elderly, 'recent data shows growing detection rates in men in their late 40s and early 50s'. 'These younger patients often present a more aggressive or advanced disease. Lack of symptoms does not mean absence of disease, as many men diagnosed with prostate cancer report only mild or vague urinary issues,' Dr Krishna said.
Although there are no clearly modifiable risk factors, he stressed that regular screening is essential. 'Prostate cancer grows slowly and responds well to treatment, allowing time for effective management — provided it is detected early. Average-risk men should start screening at age 60, and high-risk individuals with family history or genetic predispositions should begin at age 50. A yearly PSA blood test is a simple way to detect risk; elevated levels should be followed by further testing as advised by a doctor,' Dr Krishna said.
Dr Bhadrappa also highlighted the importance of early detection, advising PSA screening to begin at age 50 for most men, at 45 for those with a family history of prostate cancer, and at 40 if there's a family history of both breast and prostate cancers.
He said, 'For high-risk patients, radical prostatectomy is the most effective treatment. This surgery involves full removal of the prostate, ensuring negative surgical margins, and extended pelvic lymph node dissection. Outcomes are best when performed by experienced urologic surgeons.'
Dr Bhadrappa added that in patients with rapidly doubling PSA levels, 'cancer may spread within a year, and survival drops to 3-4 years'. He added, 'Yet, about 77 percent of high-risk patients, who undergo surgery, live beyond 10 years, proving that timely and expert intervention can significantly improve prognosis. Spot it early.'
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
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