Prostate cancer is now the most commonly diagnosed cancer in men in the United Kingdom, overtaking even breast cancer in recent years, with over 64,000 new cases recorded annually and more than 12,000 deaths every year. Approximately one in eight men in the UK will be diagnosed with prostate cancer in their lifetime, with risk increasing significantly after age 50, and even higher for Black men and those with a family history of the disease.
In recent years, diagnostic pathways have improved significantly. Men with concerning symptoms or elevated PSA levels are now referred rapidly into suspected cancer pathways that include repeat PSA testing, urine analysis, advanced MRI imaging, and, when indicated, targeted biopsies. These advances mean prostate cancer can be detected earlier and with greater accuracy than ever before, and interventions can be better tailored to the individual, including options for active surveillance, precision robotic surgery, focal therapy, and modern radiotherapy techniques.
Early detection remains crucial: men diagnosed at an earlier stage have a much greater chance of successful treatment and long-term survival, while late diagnosis, when cancer has already spread, historically led to far poorer outcomes.
Professor Prokar Dasgupta OBE, one of the world’s leading robotic urological surgeons, in an interview with Asian Voice, shed light on the early warning signs men often ignore, the modern prostate cancer diagnostic pathway, and the latest innovations helping men avoid unnecessary side effects while achieving the best outcomes.
What are the early warning signs of prostate problems that men most often ignore, and shouldn’t?
Patients can experience urinary symptoms such as slowing of the urinary stream, frequency and urgency, waking up at night to pee and blood in the urine. Although less common these days than in the past, some men present with pain in the bones. We are increasing seeing men who are diagnosed without any symptoms, simply as a result of a routine annual health check where the PSA blood test is elevated.
What does a prostate cancer diagnosis actually look like in practice today, from initial testing to treatment, and how has that pathway improved in recent years?
Most of my patients either present with a raised PSA blood test or urinary symptoms. Some of them have had the PSA blood test because they have a strong family history of prostate cancer and have been told about this by other members of the family. These days patients are seen rapidly on a suspected cancer pathway. After taking a history, I examine them, repeat the PSA along with a urine test and arrange a MRI scan of the prostate as well as a flow test which measures the strength of their stream. If the MRI is abnormal, then patients are advised to have a biopsy of the prostate. In my practice this is performed through the perineum, and not the rectum, to reduce the risk of infection.
When I was training three in four patients presented with prostate cancer that had already spread to the bones which now occurs much less frequently.
There is still confusion around PSA testing. Who should be asking for it, when, and what should men realistically expect from the results?
A single PSA test on its own is inaccurate as it can be elevated due to other reasons such as benign enlargement of the prostate (not cancer) and urine infection. Men who have abnormality of breast cancer genes called BRCA, a strong family history of prostate cancer particularly in younger men and Afro-Caribbean heritage should be asking for it. Currently there is no prostate cancer screening program for all men above 50 in the UK.
We also have more accurate genetic tests for prostate cancer based on blood and saliva and PET scans which can increase the accuracy of MRI.
Which myths about prostate cancer do you most want to dispel, especially those that stop men from coming forward early?
Whilst there is no screening program for all, those at higher risk should seek advice from their doctors. We are keen to avoid over diagnosis and over treatment. Many men with prostate cancer can be observed without any adverse effects that they fear, such as urinary leakage and difficulty with erections. Others can be treated with highly precise robotic surgery which can be personalised to individual patients using AI. Focal therapy and radiotherapy have also become very accurate and can cure the cancer without causing too many side effects.
