Father had prostate cancer? Urologist explains if you need screening sooner, how to tell if prostate enlargement is cancer and 10 FAQs men must know

HT Health Talk: Prostate cancer is common but often silent. Should you get checked earlier if your father or brother had it? Dr Shashank MS explains.

According to World Cancer Research Fund, prostate cancer is the second most common cancer in men and the fourth most common cancer overall worldwide. Despite its high prevalence, prostate health remains one of the most under-discussed aspects of men’s wellness.

Because early-stage prostate cancer often develops silently without obvious warning signs, understanding your risk factors — and knowing when to speak to a doctor — can make all the difference.

In this edition of HT Health Talk — Hindustan Times' reader-centric health and wellness Q and A series — Dr Shashank MS, consultant, urology and renal transplant, Aster CMI Hospital, Bengaluru, answered the essential questions every man and family should consider: from the role of genetics and what a high PSA (prostate-specific antigen) score actually means, to modern screening timelines, treatment options, and navigating quality of life after diagnosis.

Whether you are approaching age 50, have a family history of prostate cancer, or are supporting a loved one through a diagnosis, here is guide to help you make informed, confident health decisions.

1. How big a factor is family history, and should men get checked earlier if their father or brother had prostate cancer?

Family history is an important risk factor for prostate cancer. A man whose father or brother has had prostate cancer may have a higher risk, particularly if the relative was diagnosed at a younger age or if several close relatives are affected. Men with a strong family history should discuss screening with their doctor earlier than men at average risk. The doctor may consider age, family history, ethnicity, previous PSA results and other risk factors when deciding when to begin testing. In some families, inherited genetic changes can also increase risk, making genetic counselling or testing appropriate in selected cases.

2. Are there specific diet or lifestyle changes that actually help prevent prostate cancer?

No diet can completely prevent prostate cancer, but a healthy lifestyle may help reduce overall risk and improve general health. Men should aim for a diet rich in vegetables, fruits, whole grains, legumes and other minimally processed foods, while limiting excessive intake of processed meat, highly processed foods and foods high in saturated fat. Maintaining a healthy weight and exercising regularly are also important. Avoiding smoking and limiting alcohol can further support overall health. There is currently no supplement proven to prevent prostate cancer. Rather than relying on individual “prostate health” foods or supplements, a balanced diet and sustainable lifestyle are the most practical approach.

3. At what age should men start getting screened, and how often?

There is no single screening age that applies to every man. For men at average risk, discussions about PSA-based screening commonly begin around age 50, while men at higher risk may need to start earlier. Men with a first-degree relative diagnosed with prostate cancer, particularly at a younger age, should discuss screening around age 45 or potentially earlier, depending on their family history. Screening decisions should be individualised after discussing potential benefits and harms with a doctor. PSA testing does not necessarily need to be performed every year for everyone; the interval can depend on age, baseline PSA level, risk factors and previous results.

4. What does a PSA test involve, and what does a high score actually mean?

A PSA test is a simple blood test that measures prostate-specific antigen, a protein produced by prostate cells. A raised PSA does not automatically mean prostate cancer. PSA can increase because of benign prostate enlargement, prostatitis or urinary infection, and levels can also be influenced by certain medications and other factors. If PSA is elevated, the doctor may repeat the test, assess symptoms, perform a clinical examination or recommend additional investigations. Depending on the overall risk, this may include prostate MRI or a biopsy. PSA should therefore be interpreted in context rather than treated as a standalone cancer diagnosis.

5. How do doctors tell the difference between a normal enlarged prostate and prostate cancer?

Benign prostatic enlargement, or BPH, and prostate cancer are different conditions, although both can affect urination and sometimes increase PSA. Doctors consider several factors, including symptoms, PSA level and its pattern over time, physical examination and imaging findings. A digital rectal examination may provide information about the prostate's size and whether there are suspicious areas, although it cannot diagnose cancer by itself. Multiparametric MRI is increasingly used to identify areas that may require further investigation. If cancer remains suspected, a prostate biopsy is usually required to confirm the diagnosis. Pathological examination of biopsy tissue determines whether cancer is present and what its characteristics are.

Some prostate cancers are small, slow-growing and considered low risk, per Dr Shashank MS. (Pexels)

6. What early symptoms, like changes in urination, should prompt a man to see a doctor right away?

Early prostate cancer often causes no symptoms, which is why risk assessment and appropriate screening are important. When symptoms occur, they may include difficulty starting urination, weak or interrupted urine flow, increased frequency, particularly at night, urgency, or a feeling that the bladder has not completely emptied. Blood in the urine or semen, persistent pain in the lower back, hips or pelvis, or unexplained problems with sexual function should also be medically evaluated. These symptoms do not necessarily indicate cancer and are commonly caused by benign conditions. However, persistent or worsening urinary symptoms should not simply be attributed to ageing without medical assessment.

7. If prostate cancer is found, is immediate treatment always necessary, or can it just be safely monitored?

Immediate treatment is not always necessary. Some prostate cancers are small, slow-growing and considered low risk. For appropriately selected patients, active surveillance can be a safe approach. This involves regular PSA testing, clinical assessment, imaging and, when appropriate, repeat biopsy to detect signs that the cancer is becoming more aggressive. If there is evidence of progression, treatment can then be considered. Active surveillance is different from simply ignoring the cancer; it involves structured medical monitoring. The decision depends on factors such as cancer grade, stage, PSA level, MRI findings, biopsy results, age, overall health and the patient's preferences.

8. What are the main treatment options if prostate cancer is found early?

Treatment for early prostate cancer depends on the cancer's risk category, stage, grade, patient's age, overall health and personal preferences. Options may include active surveillance for selected low-risk cancers, surgery to remove the prostate, or radiation therapy. Radiation may be delivered externally or, in selected cases, through brachytherapy, where radioactive sources are placed within or near the prostate. Some patients may receive hormone therapy alongside radiation, depending on their risk. Treatment should be individualised rather than automatically choosing the most aggressive option. A multidisciplinary discussion involving urology, radiation oncology and other specialists can help patients understand the expected benefits, risks and alternatives.

9. How does treatment impact daily quality of life, like urinary control and sexual health?

Prostate cancer treatment can affect quality of life, although the degree varies considerably between individuals and depends on the treatment selected. Surgery can temporarily or, in some men, persistently affect urinary control and erectile function. Radiation can also cause urinary, bowel or sexual side effects, sometimes developing gradually after treatment. Hormone therapy can cause hot flashes, reduced libido, fatigue and other effects related to lowering testosterone. Importantly, treatments and rehabilitation strategies are available to help manage many of these problems. Pelvic-floor exercises, continence support, erectile-function treatments and appropriate counselling can help. Discussing these concerns before treatment allows patients to make informed decisions.

10. What is the most practical way a spouse or family member can support a loved one through screening and treatment?

The most practical support is to help the patient stay informed, organised, and emotionally supported without making decisions for him. A spouse or family member can encourage timely medical appointments, accompany him when possible, help maintain a record of PSA results and medications, and write down questions before consultations. During treatment, practical help with appointments, transportation, exercise, meals and recovery can be valuable. It is equally important to create space for honest conversations about urinary symptoms, sexual health, anxiety and treatment choices. Family members should respect the patient's preferences and privacy while reminding him that seeking professional psychological or counselling support is entirely appropriate.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.