Question 1

How common is prostate cancer?

Accepted Answer

Prostate cancer is the most common cancer in men globally — affecting 1.41 million new cases and killing 375,000 people in 2020. It is the leading cancer in 112 countries. Incidence varies dramatically by region — highest in high-income countries with widespread PSA testing; lower in Asia and Africa where testing is less prevalent. Black men have approximately 60-70% higher prostate cancer incidence and mortality than white men.

Question 2

What are the symptoms of prostate cancer?

Accepted Answer

Early prostate cancer is typically asymptomatic — detected only by PSA testing or digital rectal examination. Locally advanced or large cancers may cause: slow urinary stream; frequent urination (nocturia); difficulty starting or stopping urination; blood in urine or semen. Metastatic prostate cancer typically causes bone pain (from skeletal metastases, predominantly spine and pelvis), fatigue and weight loss. Urinary symptoms are more commonly caused by benign prostatic hyperplasia (BPH) than by prostate cancer.

Question 3

What is the PSA test and why is it controversial?

Accepted Answer

PSA (prostate-specific antigen) is a protein produced by the prostate detected in blood. Elevated PSA may indicate prostate cancer, BPH, prostatitis or prostate trauma. The controversy: PSA testing detects many slow-growing cancers that would never cause symptoms or death ("screen-detected indolent cancer"), leading to unnecessary biopsies, anxiety and treatment with side effects (incontinence, erectile dysfunction). Simultaneously, it can detect aggressive cancer at a curable stage. Guidelines have evolved toward risk-stratified, informed-decision-making approaches to PSA testing.

Question 4

What is active surveillance?

Accepted Answer

Active surveillance (AS) is a strategy for managing low-risk prostate cancer (low PSA, Grade Group 1-2, small volume) by monitoring with scheduled PSA, multiparametric MRI and biopsy — intervening with curative treatment only if criteria for progression are met. AS avoids the side effects of radical prostatectomy (urinary incontinence, erectile dysfunction) or radiotherapy (rectal problems) in men whose cancer is unlikely to cause harm during their lifetime. It requires ongoing commitment and follow-up from both patient and physician.

Question 5

How is localised prostate cancer treated?

Accepted Answer

Treatment options for localised prostate cancer: active surveillance (for low-risk disease); radical prostatectomy — surgical removal of the prostate (open, laparoscopic or robotic-assisted); external beam radiotherapy (EBRT, including stereotactic body radiotherapy/SBRT); brachytherapy (radioactive seed implantation); focal therapy (targeting only the tumour — cryotherapy, HIFU, focal laser). All curative options have similar cancer control but different side effect profiles — treatment choice is highly individualised.

Question 6

What is metastatic prostate cancer?

Accepted Answer

Metastatic prostate cancer — spread to lymph nodes or bones (most commonly) or soft tissue — was historically uniformly fatal. Treatment: androgen deprivation therapy (ADT) with GnRH agonists/antagonists reduces testosterone to castrate levels. Novel AR pathway inhibitors (abiraterone, enzalutamide, apalutamide, darolutamide) added to ADT have dramatically extended survival — the median overall survival has improved from approximately 3-4 years to 5-6+ years in mCSPC.

Question 7

What are PARP inhibitors for prostate cancer?

Accepted Answer

PARP inhibitors (olaparib, rucaparib, niraparib) target DNA repair defects in prostate cancer cells carrying BRCA1, BRCA2 or other homologous recombination repair (HRR) gene mutations. Approximately 12% of metastatic prostate cancers carry BRCA mutations. In these patients, PARP inhibitors achieve significant response rates and extend survival. Germline and somatic genetic testing is now recommended for all patients with metastatic prostate cancer to identify PARP inhibitor candidates.

Question 8

What is PSMA therapy?

Accepted Answer

Prostate-specific membrane antigen (PSMA) is overexpressed on prostate cancer cells. Lutetium-177 PSMA (lutetium-177 vipivotide tetraxetan, Pluvicto) — a radioligand therapy — delivers targeted radiation directly to PSMA-expressing cancer cells. FDA-approved in 2022 for metastatic castration-resistant prostate cancer, it significantly extends survival. PSMA PET-CT imaging simultaneously revolutionises staging and recurrence detection, identifying disease locations invisible to conventional CT/bone scan.

Question 9

How does race affect prostate cancer risk?

Accepted Answer

Black men in the US, UK and Caribbean have approximately 60-70% higher prostate cancer incidence and 2-fold higher mortality than white men. The causes are multifactorial: genetic factors (BRCA2, other variants more prevalent); higher androgen levels; less access to PSA testing and treatment; and potentially environmental factors. Current prostate cancer screening guidelines are evolving to recommend earlier and more intensive screening for Black men.

Question 10

What is benign prostatic hyperplasia?

Accepted Answer

Benign prostatic hyperplasia (BPH) — non-cancerous enlargement of the prostate — is extremely common in older men (affects approximately 50% over 60 and 90% over 85), causing lower urinary tract symptoms (LUTS): slow stream, frequency, nocturia, urgency. BPH is not cancer and does not cause elevated cancer risk per se. Management: watchful waiting for mild symptoms; alpha blockers (tamsulosin) or 5-alpha reductase inhibitors (finasteride) for moderate symptoms; surgical transurethral resection of the prostate (TURP) for severe cases.

Question 11

How does GMJ News cover prostate cancer?

Accepted Answer

GMJ News tracks GLOBOCAN prostate cancer data, PSA screening guidelines, active surveillance evidence, novel AR pathway inhibitor approvals, PSMA therapy and BRCA/PARP inhibitor developments. Prostate cancer burden in Georgia — among an ageing male population — is directly relevant to PHIG's cancer prevention and early detection programme work.

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