Prostate Cancer

At a glance

Prostate cancer is a malignant tumor that forms in a man's prostate.
It is the most common cancer in men in Korea, and the sixth most common across men and women together.

One number first.
In the 2023 national cancer registration statistics, the 5-year relative survival rate for prostate cancer is 96.9%.
It differs by stage and condition, though, so check your own case with your medical team.

Prostate cancer grows under the influence of male hormones.
Because of this, "hormone therapy" that suppresses male hormones is an important treatment.

Two things that make it different from other cancers

First, symptoms alone cannot tell you.
A poor urine flow and needing to go often appear in exactly the same way with benign prostatic hyperplasia (an enlarged prostate).
An enlarged prostate is not cancer; it is a common part of getting older.
Symptoms alone cannot tell the two apart. Only a test can.

Second, there is an option to watch instead of treating right away.
Prostate cancer sometimes grows slowly,
so watching it with regular tests instead of operating right away (active surveillance)
is one of the recognized treatment options.
It is not "why leave a cancer alone" — it means that in some cases this is the better choice.

This page is reference information that summarises official sources.
Always talk to your medical team about diagnosis and treatment.

Prostate cancer often causes no symptoms in the early stage.
Below are the symptoms the National Cancer Information Center describes, which appear once it has progressed to some degree.

• Difficulty urinating — urine does not come out well, or the stream is weak
• Blood in the urine — blood is mixed in the urine
• Pelvic pain
• Swelling of the legs (leg edema)

Something you should know

The urine-related symptoms above
appear in exactly the same way with an enlarged prostate.

• The urine stream is weak
• You get up several times at night to go to the toilet
• You feel that some urine is left after you finish
• It takes a while before the urine starts to come out

Far more often, these symptoms are the enlarged prostate that is common with age.
Having symptoms does not mean it is cancer.

The other way round, early prostate cancer causes no symptoms at all.
Having no symptoms does not mean you are safe either.
Only a test can tell.

Get tested even without symptoms if this is you

These are the risk factors for prostate cancer described by the National Cancer Information Center.

• Age — it increases as you get older. This is the biggest factor.
• Family history — if your father or a brother has had prostate cancer
• Male hormone levels
• Other environmental factors

If you have a family history in particular, see a urology department
for a consultation even if you have no symptoms.

Where to go first

The prostate is handled by the urology department (비뇨의학과).
It used to be called 비뇨기과; only the name has changed.

A local urology clinic can also do a PSA blood test and a digital rectal exam.
If urinary symptoms have been bothering you for a long time, this is where to start.

After a diagnosis

• Urology — handles surgery (prostatectomy) and hormone therapy. It is the department at the center of treatment.
• Radiation oncology — if you have radiation therapy
• Hematology and medical oncology — if you need chemotherapy
• Radiology — sometimes handles MRI scans and biopsies

Do I need a large hospital

If a biopsy confirms cancer, you will move to a general hospital or a tertiary hospital.
A tertiary hospital needs a referral letter (진료의뢰서) for national health insurance (건강보험) to apply,
so it is best to get the referral from the clinic that examined you.

Good things to bring with you:

• A record of your PSA levels (if it was measured several times, how it changed matters most)
• The biopsy result sheet
• The MRI image CD

You can look for local clinics and large hospitals together on the map.

It is not in the national cancer screening program

There is something to know first.
Prostate cancer is not one of the national cancer screening program (국가암검진) items.

The six cancers the government supports are stomach, liver, lung, colorectal, breast and cervical cancer.
Prostate cancer is not among them.

So you have to arrange it yourself.
You can add it as an optional item in a workplace health check-up,
or ask for it separately at a urology clinic.

The first tests

• PSA (prostate-specific antigen) blood test — a blood sample is taken and checked. It is the most widely used test.
• Digital rectal exam — the doctor feels the prostate directly with a finger. It is over in a moment, and it catches what PSA alone cannot. Many people avoid it out of embarrassment, but it is better to have it.

About the PSA number

The National Cancer Information Center generally treats a blood PSA of 3-4 ng per 1 ml or more as abnormal.
But this number alone does not decide that it is cancer.

PSA also rises when it is not cancer.

• An enlarged prostate
• Prostatitis (inflammation of the prostate)
• After prostate surgery or a biopsy

It also notes that normal levels are lower in Asian people than in Western people,
so applying Western thresholds as they are can miss a cancer.
Because of this, age-specific reference values, PSA density and how fast the number has been changing are looked at together.

So PSA is not a test you take once and are done with.
If you have earlier records, be sure to bring them. The change matters more than a single number.

The diagnostic stage

• Transrectal ultrasound — the prostate is viewed by ultrasound through the rectum.
• MRI — the state of the prostate is checked in detail.
• Biopsy — tissue is taken from the suspicious area and checked under a microscope. This is the test that finally decides whether it is cancer.
• Bone scan — to check whether it has spread to the bones. Prostate cancer spreads to the bones easily, so this is checked.

Treatment for prostate cancer depends on how far the cancer has progressed, your age and your general condition.
The National Cancer Information Center describes the following options.

Watchful waiting and active surveillance

This means not treating right away and watching the disease closely with regular tests.
Treatment is started depending on the test results.

Prostate cancer sometimes grows slowly,
and the burden of treatment can be greater than what treating it now would gain.
It is the recognized treatment option chosen in that situation. It is not neglect.

Radical prostatectomy

An operation that removes the whole prostate together with the seminal vesicles, the vas deferens and other nearby tissue,
and the pelvic lymph nodes as well.

Radiation therapy

• External beam radiation therapy — 3D conformal, intensity-modulated, proton therapy and others
• Interstitial brachytherapy — radioactive material is placed directly inside the prostate

Hormone therapy

Because prostate cancer grows under the influence of male hormones,
this treatment suppresses the production of male hormones to stop the cancer from growing.

Chemotherapy

At the stage where hormone therapy no longer works (castration-resistant prostate cancer),
it is given to slow the disease and reduce symptoms.

Be sure to ask when the treatment is being decided.
Surgery and radiation therapy can leave changes in urination or sexual function.
Hormone therapy also brings several changes to the body.
It may be hard to bring up, but be sure to ask your medical team
"how will daily life change if I have this treatment?"
When there are several options, this information decides the choice.

It differs by hospital, by your condition and by treatment, but the flow is usually like this.

If you are having a biopsy

A prostate biopsy is sometimes done in a day, and sometimes involves about one night in hospital.
For a few days afterwards there may be blood in the urine or semen,
so ask the hospital how much of that is normal.

If you are having surgery

1. Pre-operative tests — blood tests, an ECG, a chest X-ray and so on check that you can withstand surgery.
2. Surgery — open surgery, laparoscopic surgery or robotic surgery is chosen.
3. Recovery — a urinary catheter stays in place for a period after surgery. Some people go home with the catheter still in, and the hospital will show you how to manage it.
4. After discharge — the final biopsy result and your PSA level decide whether further treatment is needed.

Good things to bring

• A referral letter, ID, and your health insurance card
• A record of your PSA levels (older ones too, if you have them)
• The biopsy result sheet and the MRI image CD
• A list of the medicines you take (blood-thinning medicines in particular must be reported in advance)

Things to know after surgery

For a while after surgery there can be a period when it is hard to hold urine.
For most people this gets better with time, and the hospital will teach you the pelvic floor exercises
that help recovery, so follow them as shown.

The length of the stay and the course of recovery differ by hospital and by person.
Ask the hospital treating you for the exact details.

The special cost-sharing program

If you are diagnosed with prostate cancer, you can apply for the special cost-sharing program for serious illness (산정특례).
Once you are registered, your share of the cost for care related to that cancer drops sharply,
and it applies for a set period.

The hospital that issued the medical certificate usually applies for you.
If you do it yourself, submit the registration form to the National Health Insurance Service.

Costs before diagnosis are different

Prostate cancer is not one of the national cancer screening program items.
So the PSA test is not supported free of charge the way other cancer screenings are.

• In some cases it can be added as an optional item in a workplace health check-up.
• If it is done as part of medical care for urinary symptoms and the like, national health insurance may apply.
• If you have it purely for screening with no symptoms, it may be an out-of-pocket cost.

If you want to know the cost, call the hospital you plan to visit in advance.

Other things

• Depending on your income, you may qualify for the medical cost support program for cancer patients.
• For robotic surgery, whether national health insurance applies depends on the operation. Check before surgery.

The rules and your share of the cost change.
What follows is a summary as of the reference date. Before you apply, always
check the current rules with the National Health Insurance Service (국민건강보험공단).