Prostate Cancer

Prof. Dr. Abul Ahsan Didar
Patient, Proposal, Society

26

Nov 25

What is Prostate Cancer?

Prostate cancer is the cancer of the prostate gland in men which is a walnut-sized gland located below the bladder and in front of the rectum, surrounding the urethra. It produces seminal fluid that nourishes and transports sperm.1

Prostate cancer typically arises from adenocarcinoma of the glandular cells, and tumor growth can remain localized for years before spreading to regional lymph nodes, bones, and distant organs.2

Androgens, particularly testosterone and dihydrotestosterone (DHT), play a central role in stimulating both normal and malignant prostate cell growth. This biological dependency forms the foundation of hormonal therapies used in advanced disease.3

The cancer usually grows slowly, but in some cases, it can spread quickly. Usually, older men get diagnosed of the disease, but any men of any age may get affected.

What is the Incidence of Prostate Cancer Worldwide?

After lung cancer, prostate cancer ranks as the second most common cancer globally in men.  In 2022, more than 1.4 million new cases were diagnosed worldwide, with nearly 375,000 deaths attributed to the disease.4 Although historically considered more common in high-income western countries, prostate cancer is now an emerging public health issue in low- and middle-income nations, including Bangladesh, due to changing demographics, lifestyle shifts, and improved diagnostic capacity. Highest burden in North America, Europe, Sub-Saharan Africa. Incidence rising in Asia, reflecting aging populations and lifestyle changes.

What is the Prevalence of Prostate Cancer in Bangladesh?

The prevalence of prostate cancer in Bangladesh has not yet been fully determined, but its impact is increasing, especially among men in urban areas. The risk of prostate cancer rises with age, and awareness about it is low. According to GLOBOCAN 2022, Bangladesh has an estimated age-standardized incidence rate (ASIR) for prostate cancer of 8.87 per 100,000 person-years in 2019. It puts Bangladesh in the group of “low incidence” countries for prostate cancer.5 Even though, prostate cancer is common in Bangladesh, thankfully it not among the top in mortality.6

Why is the Number of Prostate Cancer Cases Increasing and in Other Asian Countries?

The rising number of prostate cancer cases across Asian countries is driven by several overlapping factors:

  • Increase in aging populations and longer life expectancy, which naturally increase cancer risk among older men7;
  • Improved detection through wider use of prostate-specific antigen (PSA) screening and advanced imaging8;
  • Genetic predispositions interacting with environmental and dietary changes further contribute to the upward trend.9,10
  • Better cancer registries and greater awareness have also made diagnoses more accurate and frequent, revealing cases that previously went unreported. According to a study in China, people receiving serial screening at least once every 4 years were at a 25% higher risk of prostate cancer detection.11
  • “Westernized” lifestyles marked by high-fat diets, red meat consumption, obesity, and reduced physical activity.

What are the Screening Tests for Prostate Cancer?

  1. Prostate-Specific Antigen (PSA) Testing
    • Widely used blood test; elevated levels may suggest cancer but are not specific.
    • PSA-based screening reduces mortality but risks overdiagnosis.12
  2. Digital Rectal Examination (DRE)
    • Useful for detecting nodules, asymmetry, or induration.
  3. Imaging
    • Multiparametric MRI improves biopsy targeting.13
  4. Biopsy
    • Transrectal or transperineal biopsy confirms diagnosis; Gleason grading evaluates aggressiveness.

Why is Prostate Cancer Screening Important?

Prostate cancer screening is important because it helps detect cancer at an early stage. When detected early, it is possible to prevent the spread of the cancer, and the patient can begin treatment quickly, which increases the chance of a cure.

What are the Problems with a National Prostate Cancer Screening Program?

The main problem with a national prostate cancer screening program is false positive results from the PSA test. This can lead to unnecessary biopsies and treatments. Additionally, over- diagnosis and over-treatment are major issues, as many slow-growing cancers would never pose a threat to the patient’s life.

Is Prostate Cancer Genetic or Caused by Environment and Diet?

Prostate cancer can be genetic, but it can also be influenced by environmental factors and diet. If there is a family history of prostate cancer, a man’s risk of developing the disease increases. In addition, an unhealthy diet, such as one high in fat and low in fruits and vegetables, and a physically inactive lifestyle can also raise the risk.

Why is Early Detection of Prostate Cancer Important?

Detecting prostate cancer at an early stage is crucial because the chances of successful treatment are much higher. When cancer is found early, it is usually confined to the prostate gland and can be fully cured with various treatment methods. Early detection also gives the patient better treatment options, which helps improve their quality of life and lifespan.

Is Prostate Cancer Curable?

Yes, prostate cancer can be curable, especially when it is caught in the early stages. The choice of treatment depends on the stage of the cancer and the patient’s overall health. Common treatments include:

  • Surgery (Prostatectomy)
  • Radiation Therapy
  • Hormone Therapy

These treatments can help the patient recover their health.

What Are the Early Symptoms/ Clinical Features of Prostate Cancer?

Prostate cancer is usually asymptomatic during the early stages. When symptomatic, it show the following features:

  • Lower urinary tract symptoms (urinary symptoms- frequency, hesitancy, weak stream, nocturia).
  • Hematuria or hematospermia.
  • Bone pain in metastatic cases.
  • Erectile dysfunction
  • Weight loss and fatigue in advanced disease.

However, these symptoms can also be caused by other health issues, so it is important to consult a physician if these are experienced.

What are the stages of Prostate Cancer?

The Tumour, Node, and Metastasis (TNM) is a way of staging prostate cancer. This TNM stage helps physician recommend the type of treatment the patient may require:

T = Tumor (in the prostate)

  • T1: Too small to see or feel — found only by test or biopsy.
  • T2: Cancer is inside the prostate.
  • T3: Cancer has started to grow outside the prostate.
  • T4: Cancer has reached nearby organs (like the bladder or rectum).

Figure: T3 stage of prostate cancer.14

Figure: T4 stage of prostate cancer.14

N = Nodes (lymph glands)

  • N0: No cancer in nearby lymph nodes.
  • N1: Cancer has reached nearby lymph nodes.

Figure: Nodes of prostate cancer.14

M = Metastasis (spread)

  • M0: Cancer has not spread to distant parts of the body.
  • M1: Cancer has spread —
    • M1a: to distant lymph nodes
    • M1b: to bones
    • M1c: to other organs (e.g., lungs or liver)

Figure: Metastasis of prostate cancer.14

Treatment Approaches

  1. Localized Disease
    • Active surveillance for low-risk disease.
    • Radical prostatectomy or radiotherapy for curative intent.
  2. Locally Advanced/High-Risk Disease
    • Radiation plus androgen deprivation therapy (ADT).
  3. Metastatic Disease
    • ADT, chemotherapy (docetaxel), novel hormonal agents (abiraterone, enzalutamide), and bone-directed therapy (NCCN Guidelines; James et al., 2017, doi:10.1056/NEJMoa1702900).
  4. Palliative Care

Pain relief, psychosocial support, and quality-of-life preservation.

What Kinds of Treatments Are Available for Prostate Cancer in Bangladesh?

In Bangladesh, various treatment methods are available for prostate cancer, such as:

  • Surgery (Prostatectomy)
  • Radiation Therapy
  • Hormone Therapy
  • Chemotherapy, which may be used in some cases.

The type of treatment chosen depends on the patient’s condition and the stage of the cancer.

Is the Goal of Treatment a Complete Cure or to Improve the Patient’s Condition?

The main goal of treatment is to cure the patient, but this depends on the patient’s condition and the stage of the cancer. If the cancer is caught in the early stages, treatment can be aimed at completely eradicating it. However, in some cases, such as with metastatic cancer, the primary goal of treatment is to improve the patient’s quality of life and slow the growth of the cancer.

Can a Prostate Cancer Patient Live a Normal Life During or After Treatment?

Yes, most patients can lead a normal life during or after treatment. While some side effects like fatigue or sexual dysfunction may occur, patients can overcome these issues with the right treatment and medical advice.

For How Many Years Do Patients Need Follow-up After Treatment?

Typically, after treatment, patients need follow-up appointments every 3-6 months for the first one to two years. After that, it’s generally recommended that they have a follow-up once a year. However, the duration of follow-up can vary depending on the patient’s condition and the type of treatment they received.

What Precautions Can Be Taken to Prevent Prostate Cancer?

Some precautions can be taken to help prevent prostate cancer, such as:

Exercising regularly

Adopting a healthy diet, with plenty of fruits and vegetables

Avoiding excessive alcohol conumption and smoking

Additionally, regular health check-ups and paying attention to early symptoms are crucial.

Challenges in Bangladesh:

  • No national screening program.
  • Limited MRI, pathology, and oncology outside Dhaka.
  • High out-of-pocket treatment costs.
  • Cultural stigma delaying health-seeking behavior.

Opportunities:

  • Integrating prostate cancer into national NCD programs.
  • Expanding oncology services to divisional hospitals.
  • Training physicians for early detection.
  • Subsidizing PSA testing and essential drugs.

September is Prostate Cancer Awareness Month. How Aware is the General Public?

Many initiatives are being taken to raise awareness, but the general public is still not fully aware of prostate cancer. Many people don’t know what the early symptoms are or when they should get regular check-ups. Therefore, it is our responsibility to educate people and inform them about their health.

Are Prostate Cancer Patients at an Increased Risk of COVID-19, like other cancer patients?

Yes, prostate cancer patients, like those with other types of cancer, are at an increased risk from the coronavirus.

Conclusion

Prostate cancer represents a significant and growing public health burden globally and in Bangladesh. While developed countries benefit from reduced mortality due to screening and treatment advances, Bangladesh lags in awareness, access, and infrastructure. Strengthening cancer registries, improving diagnostic capacity, subsidizing treatments, and launching public health campaigns are urgent steps toward narrowing this disparity

Author of this article

Prof. Dr. Abul Ahsan Didar

MBBS, MPH, MD, Senior Consultant, Medical Oncology. Ahsania Mission Cancer & General Hospital

Reference

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