Prostate cancer is the fourth most common cancer among men worldwide, including in Thailand, and remains one of the leading causes of cancer-related mortality. The incidence of prostate cancer continues to rise, making early detection increasingly important.
In its early stages, prostate cancer often causes no noticeable symptoms. Symptoms typically appear only when the disease has progressed. For this reason, regular screening—especially for men aged 45 and older or those with increased risk—is essential. Early detection significantly improves treatment success and long-term outcomes.
What Is the Prostate Gland?
The prostate gland is a small organ located below the bladder and in front of the rectum. It produces seminal fluid that nourishes and transports sperm and also helps lubricate the urethra during ejaculation.
Causes and Risk Factors of Prostate Cancer
The exact cause of prostate cancer remains unknown; however, several risk factors have been identified:
- Age: Prostate cancer is more common in men over the age of 50.
- Ethnicity: Men of African or African-American descent have a higher risk compared to other ethnic groups.
- Family History: A family history of prostate cancer increases risk. For example, men whose fathers had prostate cancer have a 2.17-fold higher risk.
- Other Factors: Lifestyle factors such as diet, sexual activity, and smoking have been studied, but current evidence does not clearly confirm a direct association.
Is Prostate Cancer Dangerous?
Prostate cancer is relatively common, but the prognosis is generally favorable. More than 80% of cases are diagnosed at an early stage, when the cancer is confined to the prostate or nearby tissues.
The five-year survival rate for early-stage prostate cancer exceeds 99% in developed countries. However, some aggressive forms of prostate cancer may progress rapidly and require immediate treatment, even when detected early.
Symptoms of Prostate Cancer
Early Stage: No Symptoms
Most early-stage prostate cancers are detected during routine health screenings, such as a digital rectal examination (DRE) or PSA blood test.
Urinary Symptoms
As the tumor enlarges, it may compress the urethra, causing:
- Frequent urination, especially at night
- Weak urine stream
- Difficulty starting or stopping urination
- Painful urination
- Blood in the urine
These symptoms may also be caused by benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate.
Symptoms of Metastatic Disease
If prostate cancer spreads, common symptoms include:
- Bone pain, fractures, or spinal cord compression
- Swelling of the legs due to lymph node involvement
Who Should Be Screened for Prostate Cancer?
Prostate cancer screening using a PSA test combined with a digital rectal exam is recommended starting at age 45.
Men with higher risk—such as those with a family history of prostate cancer or of African descent—should consider screening from age 40.
What Is a PSA Test?
- PSA (Prostate-Specific Antigen) is a protein produced by prostate tissue.
- PSA levels are measured through a blood test.
- Elevated PSA levels may indicate prostate cancer but can also be caused by benign conditions such as prostate enlargement or inflammation.
- Additional diagnostic tests may be required to determine the cause of elevated PSA.
Diagnosis of Prostate Cancer
If screening results are abnormal, magnetic resonance imaging (MRI) is used to identify suspicious areas of the prostate. A prostate biopsy may then be performed to confirm the diagnosis and assess cancer aggressiveness.
Treatment Options for Prostate Cancer
Treatment depends on the cancer stage, aggressiveness, and patient health.
Non-Metastatic Prostate Cancer
- Active Surveillance: Close monitoring without immediate treatment for low-risk cancers.
- Radical Prostatectomy: Surgical removal of the prostate gland, performed via open, laparoscopic, or robotic-assisted techniques.
- Radiation Therapy: High-energy radiation to destroy cancer cells, with outcomes comparable to surgery.
Metastatic Prostate Cancer
- Hormonal therapy to suppress male hormones that fuel cancer growth
- Chemotherapy or targeted medications
- Treatment focuses on disease control and symptom relief rather than cure
The Importance of Regular Prostate Cancer Screening
Regular screening is the most effective way to reduce the risk of advanced prostate cancer. Annual screening for men over 45 allows early detection, leading to higher cure rates and better quality of life.
