Interview: Dr Nishith explains why early detection is crucial as prostate cancer cases rise among Indian men

Hyderabad: Prostate cancer is no longer a rare or distant diagnosis for Indian men. Once considered a disease of Western populations, it is now among the most commonly diagnosed cancers affecting men in India’s urban centres.

No pain or obvious symptoms

Doctors report a steady rise in cases over the past decade, driven by longer life expectancy, lifestyle changes and wider availability of diagnostic tests. However, awareness and timely screening have not grown at the same pace.

The recent disclosure by senior journalist Rajdeep Sardesai that he was diagnosed with prostate cancer following routine medical tests has brought renewed public attention to the disease.

His experience underlined a crucial reality: prostate cancer often develops silently, without pain or obvious symptoms, and is frequently detected only when men actively opt for preventive health checks rather than seek care for illness.

Screening is ignored until late

Medical experts say this silence is one of the biggest challenges in prostate cancer management. Many men dismiss urinary changes as a normal part of ageing, while others avoid screening due to fear or misinformation.

As a result, a significant number of patients continue to present at an advanced stage, when treatment becomes more complex and outcomes less predictable.

To understand why prostate cancer remains under-detected, who is most at risk, and how early diagnosis can significantly change outcomes, NewsMeter spoke to Dr Nishith Vaddeboina, Senior Consultant Medical Oncologist at Renova Century Hospitals, Banjara Hills, Hyderabad.

Here are some excerpts from the interview:

NewsMeter: How common is prostate cancer today, especially among Indian men? Are you seeing more cases?

Dr Nishith: Prostate cancer is becoming increasingly common in India, particularly in cities. It is now among the top cancers affecting men. In clinical practice, we are definitely seeing more cases than we did a decade ago. Longer life expectancy, lifestyle changes and better access to testing are major reasons for this rise.

We are also seeing more cases being detected during routine health check-ups rather than because of symptoms, which reflects both improved diagnostics and the silent nature of the disease.

NM: Why is prostate cancer often referred to as a ‘silent’ cancer?

Dr Nishith: In its early stages, prostate cancer usually causes no noticeable symptoms. Many men feel completely well, which is why the disease often goes undetected unless screening is done. Symptoms typically appear only when the cancer is more advanced or starts affecting nearby structures.

This is precisely why proactive screening becomes important as men age.

NM: At what age should men start thinking seriously about screening?

Dr Nishith: For most men, screening should be considered around the age of 50. Men with a strong family history or other high-risk factors should start earlier, usually around 45 years, and sometimes even earlier, after discussion with a doctor.

The idea is not to create anxiety, but to identify risk early and manage it appropriately.

NM: What early warning signs should men not ignore?

Dr Nishith: Urinary problems such as difficulty starting urination, weak urine flow, frequent night-time urination or blood in urine or semen should not be ignored. However, it is important to understand that waiting for symptoms is not advisable, because many early, curable prostate cancers cause none.

By the time symptoms develop, the disease may already be at a more advanced stage.

NM: How reliable is the PSA test, and how should men view a raised result?

Dr Nishith: PSA is a useful screening tool, but it is not a definitive cancer test by itself. A raised PSA does not automatically mean cancer. It needs to be interpreted carefully along with age, prostate size, clinical findings and sometimes imaging.

The key message is not to panic, but also not to ignore an abnormal result.

NM: There is debate around routine PSA screening. What is the current medical thinking?

Dr Nishith: Today, PSA testing is not recommended indiscriminately. Screening should be individualised after discussion with a doctor. For men aged 45 to 50 years who opt for screening, PSA testing every one to two years is usually sufficient.

The decision should be based on personal risk factors and overall health rather than fear.

NM: How has MRI changed the way prostate cancer is diagnosed?

Dr Nishith: MRI has significantly improved prostate cancer diagnosis. It helps identify cancers that are clinically important and reduces unnecessary biopsies in men who are unlikely to benefit from them.

When a biopsy is required, MRI-guided biopsies are more accurate and safer, improving both diagnosis and treatment planning.

NM: How does early diagnosis change treatment outcomes?

Dr Nishith: When prostate cancer is detected early, treatment outcomes are excellent. Many men can be completely cured, and long-term survival rates are very high. Early diagnosis also offers more treatment choices, including conservative approaches that may not require chemotherapy or aggressive treatment.

It also allows patients to undergo treatment while they are otherwise healthy and active.

NM: Is prostate cancer always aggressive, or can it be monitored?

Dr Nishith: No, prostate cancer is not always aggressive. Many prostate cancers are slow-growing and may never cause harm. For selected patients, active surveillance, which involves regular monitoring with PSA tests, imaging and follow-up, is a safe and well-accepted approach.

This helps avoid overtreatment while still ensuring timely intervention if the disease changes.

NM: What are the main treatment options available today?

Dr Nishith: Treatment options include surgery, radiation therapy, hormone therapy, newer targeted therapies and chemotherapy. The choice depends on the stage and aggressiveness of the cancer, molecular testing, the patient’s overall health, and personal preferences.

Treatment today is increasingly personalised to the individual patient.

NM: Many men worry about side effects such as incontinence and sexual dysfunction. How have outcomes improved?

Dr Nishith: These concerns are understandable, but outcomes have improved significantly with modern treatment techniques. Most men regain good bladder control and sexual function often improves over time, especially with early rehabilitation and appropriate support.

Early diagnosis also helps reduce the risk of long-term side effects.

NM: What is the single most important message you would give men over 50?

Dr Nishith: Do not ignore screening. Be aware of common prostate cancer symptoms. Prostate cancer detected early is highly treatable and often curable. A simple test and timely consultation can make a major difference.

Prostate cancer remains one of the most under-recognised yet increasingly common cancers affecting men in India. Its tendency to remain silent in the early stages continues to delay diagnosis for many patients. As Dr Nishith Vaddeboina emphasises, early screening rather than symptom-driven care is key to improving survival and preserving quality of life.

Public disclosures like Rajdeep Sardesai’s diagnosis have helped bring the conversation into the open, but sustained awareness and informed decision-making are essential. For men over 50, routine screening and timely medical consultation are not just precautionary steps; they are critical tools in preventing advanced disease.