Prostate cancer in men over 50: Understanding risks and symptoms

December 21, 2023

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By Dr Meyharshnee Gunaseelan, Community Health Outreach Lead,
National Cancer Society Malaysia

Prostate cancer ranks as the 7th most prevalent cancer and the third most common among men in Malaysia, accounting for 3.6% of all male cancer cases based on the Malaysia National Cancer Registry Report from 2012 to 2016. During this period, the lifetime risk was one in 94 for all males, one in 117 for Malays, one in 72 for Chinese, and one in 108 for Indians, underscoring the crucial need for heightened awareness. Globally, prostate cancer remains a significant health concern, with over 1.4 million new cases reported annually.

The prostate is an integral part of the male reproductive system, situated just below the bladder and in front of the rectum. Roughly the size of a walnut, it envelops the urethra, playing a role in semen production.

As men age, the prostate tends to enlarge, potentially leading to benign prostatic hyperplasia—a condition causing the urethra to narrow and impede urine flow. However, it's essential to differentiate this from prostate cancer.

Understanding prostate cancer
Prostate cancer arises when cancerous cells form within the prostate tissues. Typically, this cancer progresses slowly compared to most other types. Changes at the cellular level might commence 10, 20, or even 30 years before symptoms manifest. As the disease advances, cancer cells can spread throughout the body. Notably, symptoms may only appear at an advanced stage.

Most men above 50 may not display symptoms of prostate cancer, though some might harbor precancerous or cancerous cells. Importantly, many of these cases remain dormant, never causing health concerns or symptoms leading to mortality.

Risk factors for prostate cancer
Age stands as the most prominent risk factor. Men aged 50 and above, particularly those with a first-degree relative (father, son, or brother) diagnosed with prostate cancer across multiple generations in the family, face an increased risk of developing or succumbing to prostate cancer.

Recognizing prostate cancer symptoms
Symptoms of prostate cancer vary among individuals. Most men might not exhibit any symptoms. However, seeking immediate medical attention is crucial if experiencing:

Difficulty initiating urination.
Weak or interrupted urine flow.
Frequent urination, particularly at night.
Incomplete bladder emptying.
Pain or burning sensation during urination.
Presence of blood in urine or semen.
Persistent pain in the back, hips, or pelvis.
Painful ejaculation.

Prostate Specific Antigen (PSA) test
A PSA test, measuring the PSA levels in the blood, aids in detecting prostate cancer. PSA, a substance produced by the prostate, might elevate in men with prostate cancer. Nevertheless, various factors, including age and race, can influence PSA levels. Consulting a doctor for accurate interpretation of PSA test results is crucial. An abnormal PSA level may prompt a biopsy for definitive diagnosis.

Diagnosing prostate cancer
A biopsy involves removing a small tissue sample from the prostate for microscopic examination to identify cancerous cells. The Gleason grade group, obtained from biopsy tissue examination, indicates the likelihood of cancer spread, ranging from 1 to 5, with lower scores indicating lower chances of spread.

Additional tools such as transrectal ultrasound or magnetic resonance imaging (MRI) assist in guiding the biopsy, providing detailed imaging without radiation exposure.

Cancer staging and treatment options
Upon diagnosis, staging determines whether cancer cells have spread within or beyond the prostate, guiding treatment decisions. Treatments for prostate cancer include:

Surgery (Prostatectomy)
Radiation therapy (External/Internal)
Other investigational therapies (Cryotherapy, Chemotherapy, Biological therapy, High-intensity focused ultrasound, Hormone therapy)

Prevention and men's health
Emphasizing a healthy lifestyle, comprising a balanced diet, regular exercise, and smoking cessation, significantly reduces the risk of prostate cancer. Routine screening is vital for prevention.

Men's health issues, particularly prostate cancer, demand attention. Raising awareness, advocating early detection, and promoting healthier lifestyles are pivotal in fostering longer and healthier lives for both men and women. Closing the gender health gap requires collective efforts toward a more equitable society.