Prostate cancer is a malignant tumor that occurs in the prostate, a gland unique to men that sits below the bladder and surrounds the urethra. Prostate cancer is one of the most common cancers among men in Hong Kong. Its incidence rises with age and is most often seen in men over sixty.
Prostate cancer has a distinctive feature: many cases grow extremely slowly, and some low-risk patients may not need immediate treatment, instead choosing "active surveillance." However, there are also aggressive types, so accurately assessing risk level is the key to treatment decisions.
Causes and Risk Factors
The causes of prostate cancer are not fully understood. Known risk factors include: age (the most important factor, with risk rising significantly after age fifty), family history (risk doubles for men whose father or brother has had the disease, and a family history of early-onset disease deserves even more attention), dietary habits (a high-fat diet with lots of red meat may increase risk), and obesity.
On the genetic side, BRCA1/BRCA2 gene mutations are not only linked to breast and ovarian cancer but also increase prostate cancer risk. Men with a clear family history may consider discussing screening arrangements with their doctor before age fifty.
Common Symptoms and Warning Signs
Early prostate cancer usually has no symptoms. As the tumor grows, it may press on the urethra and cause: a slower, weaker urine stream, difficulty urinating or intermittent urination, frequent urination (especially at night), and a feeling of residual urine after urinating. Note that these symptoms are almost identical to those of benign prostatic hyperplasia. Having symptoms does not mean you have cancer, but you should see a doctor to clarify the cause.
Warning signs of more advanced disease include: blood in the urine or semen, bone pain (especially lower back pain, which may be bone metastasis), and unexplained weight loss. Persistent bone pain in older men should not simply be treated as "rheumatic pain."
Diagnosis and the Concept of Staging
The PSA (prostate-specific antigen) blood test is the most commonly used screening tool, combined with a digital rectal examination to assess the size and firmness of the prostate. A high PSA does not equal cancer—benign hyperplasia and inflammation can also raise it. When PSA is abnormal, the doctor will arrange an MRI for evaluation, then use a needle biopsy to obtain tissue for a definitive diagnosis.
After diagnosis, the pathology report will provide a "Gleason score" to assess how aggressive the cancer cells are. Combined with the PSA level and examination results, the cancer is staged (stage I to IV), and patients are grouped into low-, intermediate-, and high-risk groups. This risk stratification directly determines whether active surveillance or active treatment is appropriate.
Overview of Treatment Options
Low-risk prostate cancer may be managed with active surveillance (regular PSA testing and repeat biopsies), avoiding the side effects of overtreatment. For localized tumors that require curative treatment, options include surgery (prostatectomy) and radiation therapy (external beam radiation or brachytherapy). The two have similar effectiveness but different side effect profiles (surgery has more urinary incontinence and erectile function effects, while radiation has more bowel effects), so they should be weighed carefully with your doctor.
Hormone therapy (androgen deprivation therapy) is the cornerstone of treatment for metastatic prostate cancer. New-generation oral hormone drugs (such as abiraterone and enzalutamide) clearly prolong survival. In the castration-resistant stage, there are also new options such as chemotherapy, PARP inhibitors (for those with BRCA mutations), and PSMA radioligand therapy. Prostate cancer is one of the most successful cancers when it comes to "chronic disease management."
Clinical Trials: One More Treatment Option
Clinical research in prostate cancer is very active: PSMA-targeted radioligand therapy, earlier use of new-generation hormone drugs, and immunotherapy combination strategies are all being advanced in trials.
The CancerLink platform can screen for prostate cancer clinical studies recruiting in Hong Kong based on cancer type, stage, and gene mutations. After successful matching and enrollment, study-related treatment costs are fully covered. For patients in the castration-resistant stage, clinical trials are especially worth considering.
Advice for men over fifty: during regular health checkups, it is worth discussing with your doctor whether to add a PSA test. If you are diagnosed with prostate cancer, first ask clearly about your risk level—not everyone needs immediate surgery, but everyone needs a clear plan.