【Prostate Cancer】Learn about its symptoms, causes, treatment and prevention.

According to data from the Hong Kong Cancer Online Resource Centre, prostate cancer is the third most common cancer among men in Hong Kong and should certainly not be overlooked. What are the symptoms of prostate cancer? Are there any warning signs? What treatment options are available? When do men need to undergo a prostate-specific antigen (PSA) test? How much does it cost? What are the risks and precautions during the screening process? This time, 10Life explains information about prostate cancer to help everyone safeguard their health.

The prostate is an important gland in the male reproductive system. Located between the bladder neck and the urethra, it is about the size of a walnut. It secretes a white fluid that provides nutrients for sperm and helps transport them. When sperm mixes with the fluid secreted by the prostate, semen is formed. As men age, the prostate may develop benign prostatic hyperplasia (BPH), leading to an enlarged prostate. Although the vast majority of cases of BPH are benign, abnormal cell growth can become a malignant tumour, namely prostate cancer.

According to data from the Hong Kong Cancer Online Resource Centre, there were 2,758 new cases of prostate cancer in Hong Kong in 2022, accounting for 16.0% of all new male cancer cases. The median age at diagnosis was 71, and based on the crude incidence rate, there were 82 new cases per 100,000 males. For men in Hong Kong, prostate cancer is the fourth leading cause of cancer death. In 2022, 519 men died from prostate cancer, representing 6.2% of total male cancer deaths. Moreover, the number of new prostate cancer cases has grown rapidly in recent years, with a cumulative increase of 69% between 2012 and 2022, which should not be overlooked.

The causes of prostate cancer are still not fully understood, but researchers have identified the following factors that may increase the risk of developing the disease:

• Aged 50 or above
• Men with a family history of prostate cancer
• Long-term consumption of high-calorie and high-fat foods
• Smoking, lack of exercise and obesity, etc.
   

The early symptoms of prostate cancer are not obvious. As the condition progresses, the following symptoms may appear:

• Difficulty urinating, slow urine flow, or a weak stream
• Frequent urination, especially increased urination at night
• A stinging sensation when urinating
• Blood in the urine
• Swollen legs

If the cancer has spread to the bones, it may cause pain in the lower back, groin or hips. This is usually a symptom of advanced-stage disease.

Prostate cancer screening mainly includes two tests: digital rectal examination (DRE) and a prostate-specific antigen (PSA) blood test.

• Digital rectal examination (DRE): The doctor wears gloves and gently inserts a finger into the rectum to check whether the prostate has any abnormal hard lumps or swelling.
• PSA blood test: A blood sample is taken to measure the level of prostate-specific antigen (PSA). PSA is secreted by the prostate and released into the blood, but an elevated result does not necessarily indicate prostate cancer; it may also be related to an enlarged prostate, inflammation or a urinary tract infection. Below, we will introduce the PSA blood test.

Prostate cancer screening: PSA blood test

The prostate-specific antigen (PSA) blood test can help detect cancer at an early stage.PSA blood test, short for prostate-specific antigen (Prostate-Specific Antigen). PSA is a protein produced by prostate cells, and the PSA blood test is used to measure the level of PSA in the blood. Test results are usually measured in nanograms per millilitre (ng/mL).

What is a normal PSA level?

PSA levels vary according to age and ethnicity. Below is the reference range for normal PSA levels for Asian men by age:

Does a raised PSA level definitely mean prostate cancer?

Prostate cancer cells produce more PSA than normal prostate cells, leading to higher PSA levels in the blood. Therefore, an elevated PSA level may be a sign of prostate cancer. However, a raised PSA level does not necessarily mean prostate cancer; an enlarged prostate, prostatitis and urinary tract infections can also cause PSA levels to rise.

What are the advantages of a PSA test?

The Hong Kong Cancer Fund recommends regular PSA testing, as early detection of prostate cancer can achieve a cure rate of up to 90%. In addition, if the test result is normal, it can also provide greater peace of mind.

What are the disadvantages of a PSA test?

A raised PSA level may be a sign of prostate cancer, but it may also be caused by other factors, such as an enlarged prostate or prostatitis. For those undergoing testing, if the PSA test result is positive, the process may cause anxiety and psychological stress even if cancer is not ultimately diagnosed. The Hong Kong Cancer Fund has also reminded the public that a PSA test alone cannot be used as the basis for diagnosing prostate cancer.

Who should have a PSA test?

Men aged 50 or above, those with a family history of prostate cancer, or those experiencing symptoms of prostate cancer, such as difficulty urinating, frequent urination, a stinging sensation when urinating, or blood in the urine, should undergo a PSA test.
 

What PSA screening plans are available in the market? How much do they cost?

As the early symptoms of prostate cancer are not obvious, data show that the overall five-year relative survival rate for patients with prostate cancer is 84%. Among patients in stages 1 to 3, the five-year relative survival rate remains very high, at over 97%, but this drops to 45% in stage 4. Therefore, regular screening can help detect the disease early and enable appropriate treatment. A prostate-specific antigen (PSA) blood test can also help detect cancer at an early stage.

The treatment options for prostate cancer depend on the stage of the cancer, the size of the tumour, the extent to which the cancer cells have spread, as well as the patient’s age and health condition. Common treatment methods include:

•  Active surveillance: Suitable for early-stage prostate cancer that grows slowly. The tumour is monitored through regular PSA tests, digital rectal examination (DRE) and prostate biopsy, with treatment only starting if there are signs of progression.
•  Surgery:
  o Radical prostatectomy: The prostate is removed through open surgery or a minimally invasive approach, such as robot-assisted surgery. This is suitable for localised prostate cancer.
  o Orchidectomy: The testes are surgically removed to reduce the level of male hormones (testosterone) and slow the growth of cancer cells. This is suitable for advanced or metastatic prostate cancer.
• Hormone therapy: This suppresses cancer cell growth by lowering male hormone (testosterone) levels. It can be achieved through orchidectomy or hormone medication (injection or oral medication), and is suitable for advanced or metastatic prostate cancer.
• Radiotherapy: High-energy rays are used to destroy cancer cells, including external beam radiotherapy (EBRT) and brachytherapy. This is suitable for localised prostate cancer or to prevent recurrence after surgery.
• Chemotherapy: Suitable when cancer cells have spread and hormone therapy is ineffective. Chemical drugs are used to attack cancer cells, but there may be more significant side effects.
   

Regular follow-up consultations

Regular follow-up consultations help to monitor the condition. After treatment, a PSA test should be carried out every 3 to 6 months to ensure the cancer has not recurred. If PSA levels are abnormal, further examinations such as an MRI or CT scan may be required.

Maintain a balanced diet

Consume more fruit and vegetables, whole grains and healthy protein sources (such as fish and soya); reduce red meat, processed meats and high-fat foods; and avoid alcohol and sugary drinks to lower the risk of recurrence.

Engage in moderate exercise

It is recommended to maintain 150 minutes of moderate-intensity exercise each week, such as walking, swimming or yoga.

Stay positive

Talk to family and friends and maintain a positive mindset; learn relaxation techniques such as meditation and deep breathing; or join a support group to ease feelings of anxiety.
 

• Quit smoking and drink less alcohol
• Adopt healthy eating habits
• Manage your weight
• Check testosterone levels
• Undergo regular prostate cancer screening

According to data from the Hospital Authority of Hong Kong, the average cost of prostatectomy in public hospitals is approximately HK$72,050 to HK$88,300, while each session of radiotherapy can cost up to HK$57,170. The costs are even higher in private hospitals. Therefore, purchasing critical illness insurance and voluntary health insurance in advance can provide a lump-sum payout in the event of a serious illness, while also easing the burden of medical expenses.

If you are a man aged 40 or above, or if you have a limited budget, you may consider term critical illness insurance. Term critical illness insurance is a non-savings product and has no cash value, so the premiums are relatively low. If the insured is unfortunately diagnosed with a major illness such as prostate cancer, the insurer will pay a sum assured in accordance with the policy terms.

If you are a younger man, you may consider whole life critical illness insurance. Whole life critical illness insurance provides lifelong protection, and most policies allow multiple claims. In addition, if no claim has been made, you may be able to recover the cash value upon surrender.

As a Hong Kong insurance comparison platform, 10Life has introduced an actuarially designed scoring system to compare different insurance products fairly, enabling consumers to choose the most suitable insurance product for their needs. Check out the Term Critical Illness Insurance Comparison and Whole Life Critical Illness Insurance Comparison now to learn more.

Source: Cancer Online Resource Centre, Hospital Authority, university hospital data, Cancer Fund

Last updated: 3 March 2025

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.