KUALA LUMPUR, Dec 22 — Prostate cancer remains one of the most misunderstood cancers among Malaysian men, despite being the third most common cancer affecting men in the country.

According to the Malaysian National Cancer Registry Report (2017–2021), nearly three out of four cases are diagnosed at an advanced stage. While awareness around men’s health has improved over the years, late diagnosis remains a persistent and worrying trend.

According to Dr Arnil George Sirimanne, consultant in clinical oncology from Icon Oncology, a significant number of patients continue to present with advanced-stage prostate cancer, where the cancer has spread to the bones and symptoms have become severe.

Misconceptions about prostate cancer can often delay diagnosis and treatment. In this piece, Dr Arnil addresses these common myths and shares the facts you need to know.

Myth 1: Prostate Cancer Only Affects Older Men

One of the major reasons for this, he says, is the enduring belief that prostate cancer affects only the elderly. “Once you cross 60, the risk is real as 85 per cent of prostate cancer cases affects men who are 60 years old and above. But 15 per cent are diagnosed for men below 60. This leads to men not going for screening in their 40s and 50s, resulting in late detection of this disease.”

The early stages of prostate cancer are almost always silent. Symptoms such as difficulty urinating, a weak stream, or urine leakage after urinating are usually dismissed as part of ageing.

More serious warning signs like persistent back pain, pelvic discomfort or unexplained weight loss often appear only after the cancer has spread, usually to the spine or pelvic bones.

By the time these advanced symptoms surface, treatment becomes more complex, and survival rates drop.

Myth 2: Prostate Cancer Doesn’t Affect Asian Men

Many Malaysian men still incorrectly believe that it is a “Western man’s cancer”, assuming that Asians are less likely to develop it.

“This is absolutely not true,” says Dr Arnil. “It’s a global cancer. Western countries appear to have higher numbers mainly because they have stronger screening and advocacy, not because Asians are biologically ‘safer’.”

In Malaysia, many men do not go for routine screening and often underestimate their own risk. As a result, they tend to seek medical attention only when symptoms become hard to ignore.

Myth 3: High PSA Reading Means Prostate Cancer

Another widespread misunderstanding revolves around PSA (prostate-specific antigen) testing. PSA is an important test for early detection, but a high PSA reading does not always mean cancer.

It could indicate benign enlargement of the prostate or inflammation. Even so, many men panic when they see an elevated PSA result, while others avoid testing altogether for fear of what it might reveal.

Dr Arnil emphasises that what men should be doing instead is seeking proper evaluation by a urologist, who will be able to determine whether further investigation is needed.

Despite the prevalence of misconception and fear, early detection remains the single most powerful factor in improving prostate cancer outcomes. With timely diagnosis, many men can live for well over a decade following treatment.

Diagnosis And Treatment For Prostate Cancer

In addition to the PSA test and digital rectal examination, doctors may use multiparametric MRI, PSMA PET scans and a biopsy to confirm whether prostate cancer is present and how aggressive it is.

Dr Arnil explains, “Once a diagnosis is confirmed, treatment depends on how far the cancer has progressed. Doctors assess whether it is still inside the prostate or has already spread.”

Each stage requires a different approach; cancer treatment is never one-size-fits-all. For men diagnosed at an early stage, treatment may not need to begin immediately. Instead, they may be placed on active surveillance, a structured programme of close monitoring with repeat tests and scans. This approach helps patients avoid unnecessary treatment while ensuring that any progression is detected promptly.

When treatment is needed for cancer that is still inside the prostate, common options include removing the prostate (robotic prostatectomy), or treating it with radiotherapy. Radiotherapy can be given from outside the body or by placing small radioactive sources inside the prostate.

For men whose cancer is still in the prostate but appears more active, doctors may add short-term hormone therapy to radiotherapy. This helps make the treatment more effective and improves long-term control of the cancer.

For advanced prostate cancer, there are several treatment options. Treatment options include hormone therapy, chemotherapy and radiotherapy which can help to improve outcomes and quality of life.

Doctors choose the right combination based on each person’s needs and specific characteristics of the cancer.

“We now have very effective oral and intravenous treatments that can extend life even for patients with widespread cancer,” Dr Arnil says, underscoring how much the field has advanced compared to a decade ago.

Importance Of Multidisciplinary And Holistic Cancer Care

Managing prostate cancer requires more than the right medications and technology. Dr Arnil emphasises that high-quality care depends on strong collaboration across different specialties.

“I believe in a holistic and end-to-end approach in cancer care, including screening, diagnostics, treatments and psychosocial support. Prostate cancer treatment requires a multidisciplinary team – urologists, oncologists, radiologists, nuclear medicine physicians, pathologists and cancer support professionals. Everyone plays an important role in delivering the best possible holistic treatment plan.”

Early Detection Is Vital

Many specialists encourage men to begin prostate cancer screening from around age 50, or earlier from age 40 if they belong to a higher-risk group such as having a family history of the cancer.

For many men, fear, embarrassment and misunderstandings about the screening process remain major barriers, yet prostate cancer is highly treatable when found early.

Today’s diagnostic tools and treatments are highly effective. Many men overcome the disease and maintain a good quality of life when it is found early.

“Do not ignore symptoms, no matter how small. Don’t assume you’re too young and don’t be afraid to get your PSA checked,” says Dr Arnil.

“If your PSA is raised, don’t panic. See a doctor and get evaluated properly. In the end, it comes down to taking charge of your health. We want to detect cancer early so we can treat it effectively. Give yourself the best chance.”