Prostate cancer is the most commonly diagnosed cancer among South Korean men. It ranked ninth among male cancers in 1999 but rose to first place in 2023. Cases are climbing quickly on the back of population aging, Westernized diets and wider use of prostate-specific antigen (PSA) testing.
"Incidence rises sharply with age, and Westernized eating habits such as high-fat diets and red meat also play a role," said Choi Jung-won, a professor of urology at Chung-Ang University Gwangmyeong Hospital. "The spread of PSA testing has also increased the number of patients detected at an early stage."
Prostate cancer has a high survival rate, but the outlook changes substantially when the tumor is highly aggressive or has spread to the bones or elsewhere. Robotic surgery is now widely used to remove the prostate, which sits deep inside the pelvis, with enough precision to preserve the urethra, nerves and other surrounding structures as much as possible.
On Seoul Economic Daily TV's program "Now, the Specialist," airing at 9 p.m. on the 12th, Choi discusses everything from early detection to robotic surgery, radiation and drug therapy, and the recovery of urinary and sexual function after surgery.
Robots Handle 90% of Prostate Surgery, Preserving Urethra and Nerves
Because the prostate lies at the deepest point of the pelvis, clear visibility and precise handling are critical during surgery. Robotic systems offer a magnified view and flexible instrument articulation, allowing surgeons to identify the bladder, urethra and nearby nerves in fine detail as they operate.
"Close to 90% of prostate cancer surgeries are now performed with robots," Choi said. "It is advantageous for reducing bleeding and preserving the urethra and surrounding structures."
Alongside conventional multi-port robotic surgery, which requires four to five incisions, single-port robotic surgery centered on a single incision is also becoming more common. For high-risk or advanced cancers that require pelvic lymph node dissection, however, conventional multi-port surgery may be more suitable. The scope of surgery has widened as well. In the past, operations were mostly limited to early-stage tumors confined to the prostate, but aggressive strategies combining surgery with radiation and hormone therapy are now used even for locally advanced prostate cancer that has invaded the seminal vesicles or pelvic lymph nodes.
Early Detection Through PSA Testing
Prostate cancer can appear as early as a patient's 40s, but cases begin to rise from the 50s and are most often found in patients in their 60s and 70s. Family history is another important risk factor. Early detection relies on the PSA blood test. A high PSA reading does not always mean cancer; doctors also assess prostate size and how fast PSA levels are rising before ordering an MRI and biopsy if needed.
Prostate cancer generally progresses slowly and responds well to treatment, but not every case is benign in practice.
The Gleason score determined by biopsy is the main indicator of how aggressive a tumor is. A score of 6 is considered relatively low risk, 7 intermediate risk, and 8 to 10 high risk, with a greater likelihood of progression and recurrence. Patients with low-risk prostate cancer may opt for active surveillance, monitoring the disease through PSA readings, MRI scans and biopsies rather than starting treatment immediately. Because tumor characteristics differ from patient to patient, however, careful risk assessment is essential.
Radiation Also Aims for a Cure; Hormone Therapy for Metastatic Cases
In prostate cancer, radiation therapy as well as surgery is administered with the goal of a cure. External beam radiation, delivered from outside the body, is the most common approach, while brachytherapy, which places radioactive material inside the prostate, is also used.
"For low- and intermediate-risk prostate cancer, radiation therapy delivers good outcomes that are not much different from surgery," Choi said.
Proton and carbon-ion therapy concentrate energy on the tumor to limit damage to surrounding healthy tissue. Patients need to weigh the limited number of facilities offering these treatments and their high cost.
For metastatic prostate cancer, hormone therapy that suppresses male hormones is central. Because prostate cancer grows under the influence of male hormones, blocking them slows the disease.
Treatment options are expanding for castration-resistant prostate cancer, which develops resistance to hormone therapy. In addition to newer hormonal agents and chemotherapy, along with PARP inhibitors used in patients with BRCA gene mutations, radiopharmaceuticals that seek out prostate cancer cells and deliver radiation directly to them are now in use.
Incontinence Mostly Improves Within a Year; Sexual Function Takes Longer
The side effects patients worry about most after prostate cancer surgery are urinary incontinence and erectile dysfunction. The sphincter that controls urination and the nerve bundles involved in erection lie close to the prostate. According to Choi, incontinence is common immediately after surgery, but about half of patients return to near-normal function after three to six months, and roughly 90% recover after a year. Erectile function requires more time for nerves to heal, so doctors typically monitor patients for at least a year and often about two years. Pelvic floor exercises such as Kegel exercises, started before surgery, help recovery. After surgery, penile rehabilitation using medication and other approaches can be pursued as needed.
"Many prostate cancer patients are elderly and some give up on treatment, but the burden of surgery has eased and treatment options have grown more varied," Choi said. "What matters is actively pursuing the treatment that fits your stage and risk level."
