Prostate cancer is not just the most common cancer in men these days, but it is also a major cause of mortality and morbidity in men worldwide. The 2022 estimates by the American Cancer Society suggest that over 34,500 patients die of prostate cancer every year (1 in 41 prostate cancer cases).1

The mortality rate of this cancer is majorly due to patients presenting in late stage i.e. stages 3 or 4. This is despite several advanced screening procedures being available in most countries and is largely driven by wrong notion of associating prostate cancer with troublesome lower urinary tract symptoms (LUTS) in both patients and clinicians alike. Even national guidelines and charities and media have been recommending people to look for LUTS as a sign of prostate cancer. This is mainly due to observation of symptoms like urine retention and slow urinary flow followed by increased frequency of urination or nocturia in prostate cancer patients.

Another common notion is the presence of an enlarged prostate gland in prostate cancer. Association between prostate size and cancer has been studied for ages. In recent MRI-guided studies, it is evident that there is an inverse relationship between prostate size and prostate cancer  the mean prostate volume is lower in patients with prostate cancer than those with benign tumors.

Studies now suggest that the enlarged prostate may cause mechanical suppression of tumor growth. One of the first studies to suggest that there exists no relationship between urinary symptoms and prostate cancer is the HUNT 2 Study conducted in Norway from 1995 to 2007. The Gothenburg screening trial and the more recent, PROTECT Study corroborated this finding and further suggested that there is an inverse relationship between urinary symptoms and a positive biopsy finding.

However, more than 86% of the population worldwide still associate LUTS with prostate cancer and only 1% agree that prostate cancer can be asymptomatic.

There is thus an urgent unmet need to correct the current public messaging on urinary symptoms and instead recommend appropriate screening strategies for prostate cancer detection. While PSA testing with demographic and comorbidity factors can aid in the primary screening of all patients, prostate MRI has shown to provide high negative prediction values and can help in early cancer detection without the need for biopsy testing. Efforts should be made by guideline societies, charities, and media as well to raise awareness amongst the public that prostate cancer can be asymptomatic and hence early screening may help in early detection, better prognosis, and timely treatment.

References:

1. https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed on 19 Sept 2022.

2. Gnanapragasam VJ, Greenberg, D, Burnet, N. Urinary symptoms and prostate cancer-the misconception that may be preventing earlier presentation and better survival outcomes. BMC Med. 2022;20(1):264.