[Sportschosun, Jang Jong-ho] Prostate cancer has become the most commonly diagnosed cancer among men in South Korea. According to data released by the Cancer Registry Center in 2026, 22,640 new cases of prostate cancer were reported in 2023, accounting for 15.0% of all cancers diagnosed in men. This surpassed the 21,846 new cases of lung cancer. Prostate cancer often causes no noticeable symptoms in its early stages, and it is difficult to determine whether cancer is present or how far it has progressed based solely on urinary symptoms such as a weak urine stream or frequent urination.
Lee Jang-hee, chief of urology at Incheon Himchan General Hospital, explained, "Symptoms such as a weak urine stream and frequent urination are common in benign prostatic hyperplasia, while early prostate cancer is usually asymptomatic and may cause urinary symptoms similar to those of benign prostatic hyperplasia as it progresses." He added, "Because urinary symptoms vary depending on the degree of urethral narrowing and bladder contractility, their severity does not directly indicate whether prostate cancer is present or how advanced it is."
◇ 5-year relative survival rate is 51.2% at the distant metastatic stage
The prostate is an organ located below the bladder that surrounds the urethra. Although both conditions develop in the prostate, benign prostatic hyperplasia and prostate cancer usually begin in different areas. Benign prostatic hyperplasia occurs when transitional-zone tissue near the urethra enlarges and compresses the urinary passage. This can cause a weak or interrupted urine stream, difficulty urinating without straining, frequent urination, nighttime urination, and a feeling of incomplete bladder emptying.
By contrast, prostate cancer usually develops in the peripheral zone, the outer part of the prostate away from the urethra. When the cancer is small and confined to the prostate in its early stages, it often does not affect the urethra, so urinary function may remain normal.
If the cancer progresses locally and affects nearby structures such as the urethra or bladder, it may cause difficulty urinating, urinary retention, blood in the urine or semen, and pelvic pain. When it spreads to the bones, pain in the lower back or pelvis may occur. In severe cases, weakness or sensory changes caused by spinal cord compression may also develop. Therefore, urinary symptoms can prompt an examination, but the absence of symptoms does not rule out prostate cancer.
The prognosis of prostate cancer varies markedly depending on the stage at diagnosis. According to the National Cancer Information Center’s “Five-Year Relative Survival Rates by Summary Stage for Major Cancer Types, 2019–2023,” the five-year relative survival rates were 103.6% for localized cancer confined to the prostate and 101.1% for regional cancer that had spread to nearby tissues or lymph nodes. By contrast, the rate fell sharply to 51.2% at the distant stage, when the cancer had spread to remote parts of the body. It is therefore important not to wait for symptoms, but to undergo testing based on risk factors such as age and family history so that the cancer can be detected before it spreads.
◇ PSA testing recommended from age 50—A single reading is not enough for a diagnosis
The test most widely used for the early detection of prostate cancer is a blood test for prostate-specific antigen (PSA).
PSA is a protein produced by prostate epithelial cells. Its level in the blood may rise when abnormalities such as cancer develop in the prostate, so it is used to assess the possibility of cancer before symptoms appear. A digital rectal examination is also used as a basic test to check for abnormalities such as hard areas or asymmetry in the prostate. In this examination, a doctor feels the prostate through the anus to identify such findings. However, neither test can confirm cancer; both are initial steps in determining whether further diagnostic testing is needed.
The European Association of Urology’s 2026 prostate cancer guidelines recommend that men without specific risk factors begin PSA testing at age 50. If a father or brother was diagnosed with prostate cancer before age 60, testing should be considered from age 45; for men with a BRCA2 gene mutation, it should be considered from age 40. The interval between subsequent tests is not fixed and should be adjusted according to the risk indicated by the initial PSA level. If the initial PSA level is low and risk factors are limited, the interval before the next test may be extended. If the level is high or there is a family history, closer monitoring is recommended. The decision to begin testing and the testing interval should be determined with a medical professional, taking overall health into account.
A high PSA level does not necessarily mean prostate cancer. Levels can also rise with benign prostatic hyperplasia, prostatitis, urinary tract infections, and acute urinary retention, as well as after recent ejaculation or urological procedures. Conversely, a low PSA level cannot completely rule out prostate cancer. Because some prostate cancer patients may have PSA levels within the normal range, additional testing should be used to assess the possibility of cancer if a digital rectal examination reveals abnormalities such as a hard nodule or asymmetry, even when PSA is low. Rather than determining the presence of cancer from a single reading, results should be interpreted comprehensively alongside repeat-test findings, age, family history, and prostate volume.
Lee Jang-hee, chief of urology at Incheon Himchan General Hospital, said, "Rather than applying the PSA threshold of 4.0 ng/mL as an absolute cutoff for determining whether cancer is present, we carefully assess the need for a biopsy by considering PSA density, repeat-test results, and prostate MRI findings together." He added, "The most basic way to detect prostate cancer early is to determine your PSA level at an appropriate age, even when you have no symptoms, and regularly track changes in the level over time."
Jang Jong-ho, Reporter bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
