Doctors say prostate cancer risk rises notably after age 50, though it can occur earlier. Family history and diets high in red meat but low in fruits and vegetables also elevate the risk
Published May 20, 2025 | 6:00 AM ⚊ Updated May 20, 2025 | 6:00 AM
Pain during urination can be signs of prostate cancer. (Creative Commons)
Synopsis: President Joe Biden’s prostate cancer diagnosis has drawn global attention to a largely silent yet deadly disease affecting millions of men. Dr Pramod Krishnappa of NU Hospitals, Bengaluru, citing 2024 ICMR data, noted that 43% of prostate cancers in India are diagnosed at an advanced stage. He advocates routine annual blood tests to improve early detection and treatment outcomes
When global leaders fall ill, the world watches. President Joe Biden’s recent diagnosis of prostate cancer has not only sparked concern but also highlighted a silent killer that affects millions of men globally — often without symptoms, without warning, and far too often, without a timely diagnosis.
Speaking to South First, internationally renowned Consultant Uro-Andrologist at NU Hospitals in Bengaluru Dr Pramod Krishnappa explains, “as per the recent ICMR data published in Indian journal of Urology in 2024 revealed a very astounding fact that around 43 percent of all prostate cancers were diagnosed at the distant metastatic stage, which means, out of 100 patients 43 were diagnosed at a very late stage, during which the outcomes of the treatment may not be that great. So, it’s high time that we must include a simple blood test to detect prostate health issues in ones annual health check.”
Speaking to South First, a senior Oncologist from Kidwai Hospital in Bengaluru says, “the prostate is a small glad in men, located below the bladder and in front of the rectum, responsible for producing seminal fluid.”
Explaining further he adds, “Prostate Cancer occurs when cells in the prostate begin to grow uncontrollably. Most cases grow slowly, but some can be aggressive and spread rapidly,” he explains.
President Biden, according to a press statement has been diagnosed with an “aggressive” form of prostate cancer. He was diagnosed with the disease after he experienced few urinary symptoms, and on examination a prostate nodule was found. The treatment options are now being worked out.
“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive, which allows for effective management. The president and his family are reviewing treatment options with his physicians,” said the statement from the Democrat’s office on Sunday. The statement also says that the cancer was found to have a Gleason score of 9 (Grade Group 5).”
Explaining what it means, Dr Pramod says, Prostate cancer that looks “very abnormal” is assigned the highest rating. He explained that International Society for Urological Pathology says ISUP grade 4/5 or if the Prostate Specific Antigen is above 20 ng/ml based on the digital rectal examination then it is considered as high risk.
Simplifying further he said, “basically if prostate cancer has spread beyond the prostate and involving other nearby or distant organs it is considered as ‘aggressive’.”
According to reports, in Biden’s case, the cancer has reportedly spread to his bones.
According to doctors the risk for prostate cancer increases significantly after the age of 50 years. However, there have been cases where even those in their 40s have been detected with prostate cancer.
Having a family history where men with a father or brother who had prostate cancer are more likely to develop it. Also, diets high in red meat and low in fruits and vegetables may increase cancer risk.
Dr Pramod however says, “the early prostate cancer may not give any kind of symptoms however sometimes one may see blood in the urine, unintentional weight loss and some vague prosthetic symptoms like increase in frequency of urination, burning while passing urine.”
Dr Pramod warns that blood in the urine is somthing that no body should ignore. Meanwhile Dr Madhavi Nair says, men above the age of 50 often have issues like sleep disturbances and struggles to use the bathroom.
“As prostate cancer is easily detectable through PSA blood test. However, Benign Prostatic Hyperplasia can also have similar symptoms like prostate cancer. Hence they may assume ‘this is nothing serious; my friend has it too and it is only BPH, so even I probably just have that,” etc. So one should not ignore any symptoms of changes and meet a urologist for further evaluation.”
Prostate cancer is the second most common cancer in men worldwide, says a study published by researchers from Global Center for Evidence Synthesis of Chandigarh, in Science Direct in Febraury 2025 on “understanding Current trends incidence projections of prostate cancer in India: A comprehensive analysis of national and regional data from the global burden of disease study (1990-2021).” The study says prostate cancer is the fifth leading cause of cancer-related mortality among male patients and fourth most common cancer worldwide.
“In India, the trends and burden of Prostate Cancer have been understudied compared to Western countries. However, with the rapid socio-economic development and adoption of Western lifestyles, there has been an observed increase in the incidence of PC. This trend highlights the need for comprehensive epidemiological studies to understand the scope of the problem better and to inform public health strategies,” argued the authors of the study. Yet, awareness remains shockingly low.
“Men often don’t come forward for checkups until it’s too late,” says Dr Shivalingaiah, renowned urologist from Bengaluru. “Unlike women’s health where there is a visible push for breast and cervical cancer screening, prostate health is still not part of regular conversations or public health policy,” he adds.
Meanwhile Dr Madhavi Nair, Consultant-Surgical Oncology at Manipal Hospital says, there is a lot of stigma around prostate cancer mainly because it affects elderly men. “Many patients, often over 70, experience symptoms like difficulty urinating, frequent night time bathroom trips, and a sensation of incomplete emptying.”
The study found the highest number of cases were found in Delhi, Kerala, and Mizoram and Uttarakhand. Meanwhile Dr Shivalingaiah explains that according to National Cancer Registry Programme (NCRP) data for 2012-2016, the age-adjusted incidence rate of prostate cancer in Bengaluru (a major urban center in Karnataka) was approximately 6.0 per 100,000 men. “This is lower than some other urban registries like Delhi (11.8 per 100,000) and Mumbai (9.7 per 100,000) but indicates a significant burden in urban Karnataka,” he explained.
Unlike many other cancers, prostate cancer, when detected early, has a very high survival rate. Simple screening tools like PSA (Prostate-Specific Antigen) blood tests and digital rectal exams (DRE) can catch early-stage disease before it spreads.
However, India does not have a national prostate cancer screening program. Even in many state-run hospitals, there is no standardised protocol for screening men above 50.
“This is a gap in our healthcare strategy,” says a preventive medicine expert from Karnataka. “Just as we screen women for breast cancer, we need regular prostate cancer screening camps at the PHC level, especially for men over 50 or those with a family history of cancer,” she adds on condition of anonymity.
States like Kerala and Tamil Nadu, known for better healthcare indices, have introduced non-communicable disease (NCD) screening programs — but prostate cancer is often missing from the checklist.
Dr Pramod says, “offer early PSA testing to well-informed men at elevated risk of having PCa:
Men from 50 years of age
Men from 45 years of age and a family history of PCa
Men carrying breast cancer gene 2 (BRCA2) mutations from 40 years of age.”
A major barrier is cultural stigma. Discussions around men’s reproductive organs are still taboo in many Indian homes. Prostate health, which involves the urinary and sexual systems, is shrouded in embarrassment and silence.
“For years, I ignored the symptoms — frequent urination, slight pain — thinking it was old age,” says 68-year-old Rajan, a retired banker from Bengaluru. “It wasn’t until my daughter, a nurse, insisted I get tested that I found out it was cancer.”
This silence can cost lives. There needs to be a cultural shift in how men approach health. Campaigns that normalize discussions around prostate health, much like those done for menstrual hygiene or mental health, are urgently needed.
Senior doctor from Kidwai says, “prostate cancer awareness begins with conversation. Talk to your doctor about your risk, especially if you are over 50 or have a family history. Encourage the men in your life to stay informed and proactive about their health.”
Doctors stress that early detection saves lives. “Let’s raise awareness, break the stigma, and promote routine check-ups. Together, we can fight prostate cancer,” adds the doctor.
Dr Pramod explains that “traditionally, probably two decades back, if someone has been diagnosed with PC it used to be usually the radiotherapy. But in early 2000, with the advent of surgical robots, there has been a major shift from radiotherapy to radical prosthetic surgery, where the surgeries are very precise and give excellent results. Not just the cancer outcomes but also in terms of functional outcomes like sexual health and urinary leakage.”
He says, the main concerns after somebody’s diagnosis of prostate cancer or somebody plans for a prosthetic surgery, the two functional concerns would be erectile dysfunction and persistent urinary leakage. However, with the advent of robotic surgeries, these two complications can be prevented to the maximum extent possible. Even if someone gets ED or urinary leakage there are other measures or therapies and treatments which includes penal implants too.
Meanwhile Dr Madhavi Nair says, there are several new and effective treatment options for prostate cancer. “Fortunately, it is a slow-growing cancer and responds well to multiple lines of treatment. Robotic surgery, especially robotic radical prostatectomy, has transformed prostate cancer care offering a less invasive, low-morbidity procedure with faster recovery and abetter outcomes, so the open surgery is rarely needed.”
She adds that there are a lot of new lines of hormonal treatment. And now they are exploring PSMA-directed therapy and high-density frequency ultrasound. These are all new therapies that are coming up.”
In addition to surgery, advanced hormonal therapies, PSMA-targeted treatment, and high-intensity focused ultrasound (HIFU) are showing promise,” she said.
She adds that since prostate cancer is one of the most common cancers in the world, and it is going to only increase because “our population is trending towards a larger section of men being in the above 70 years age group we are definitely going to see a lot more of prostate cancers.”
(Edited by Ananya Rao)
