Prostate cancer rising beyond metros as doctors warn half of patients are diagnosed too late

Prostate cancer is emerging as a growing health concern beyond India's metropolitan cities, with specialists reporting a steady rise in patients from smaller towns and neighbouring states while warning that delayed diagnosis continues to push many cases into advanced stages when the disease is no longer curable.

The warning comes amid a broader increase in prostate cancer incidence in India, driven by an ageing population, improved life expectancy and greater awareness. However, unlike many Western countries where routine prostate-specific antigen (PSA) screening helps detect the disease early, doctors say many Indian men seek medical attention only after the cancer has spread to the bones or spine, leading to serious complications.

Dr. Ashwin Mallya, Uro-Oncologist and Robotic Surgeon at Sir Ganga Ram Hospital, said the profile of patients has changed significantly over the past few years.

"We are definitely seeing more prostate cancer than we did a few years ago. Earlier, most of these patients came from big cities. Today, a large number of people coming to us are from Uttar Pradesh, Bihar, Haryana and other smaller towns. That tells us awareness is improving, but many men are still reaching us too late," he said.

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Dr. Mallya said the PSA blood test remains the first step in detecting prostate cancer at an early stage.

"If the PSA is abnormal or there is suspicion during examination, we then use tests like multi-parametric MRI and MRI-TRUS fusion biopsy to confirm the diagnosis. These investigations have made diagnosis much more accurate and help us identify cancers that need treatment," he said.

Despite wider awareness of PSA testing, late diagnosis remains a major concern.

"Despite increasing awareness about PSA testing, roughly 50 per cent of prostate cancer patients I see in practice are already in Stage 4. At that stage, we can only control the disease, not cure it," Dr. Mallya added.

Back pain may signal advanced disease

Doctors say one of the most overlooked signs of advanced prostate cancer is persistent back pain. Once the cancer spreads to the vertebrae, it can compress the spinal cord and surrounding nerves, causing progressive weakness, numbness and even paralysis if treatment is delayed.

Dr. Praveen Gupta, Chairman of the Marengo Asia International Institute of Neuro and Spine (MAIINS) at Marengo Asia Hospitals, Gurugram, said many patients first visit neurologists rather than cancer specialists.

"Sometimes patients don't come to a neurologist because of prostate cancer. They come because they are unable to walk properly, have severe back pain or suddenly develop weakness in their legs," he said.

He said spinal cord compression caused by metastatic prostate cancer is a medical emergency.

"Once prostate cancer reaches the bones, especially the spine, it can press on the spinal cord. That's when patients may develop severe back pain, weakness in the legs, numbness or even paralysis. Many of these complications can be avoided if the disease is diagnosed earlier."

Dr. Gupta urged people not to ignore neurological symptoms.

"When someone develops weakness, numbness or loses control over bladder or bowel function along with persistent back pain, it should be treated as a neurological emergency. Every hour matters. These patients need immediate evaluation by neurologists, urologists, oncologists and spine surgeons. If treatment is delayed, the damage can become permanent," he said.

Early screening can improve outcomes

Doctors say prostate cancer is among the most treatable cancers when detected early, making awareness and timely screening critical. Men aged 50 years and above—or earlier if they have a family history of the disease—should discuss PSA screening with their doctor, particularly if they experience persistent urinary symptoms, unexplained bone pain or prolonged back pain.

Dr. Mallya said early diagnosis not only improves survival but also helps prevent life-altering complications associated with advanced disease.

"The biggest message is that prostate cancer is highly treatable if detected early. Men should not ignore persistent urinary symptoms or unexplained back or bone pain. Seeking medical advice at the right time can make the difference between curative treatment and lifelong disease control," he said.