Former US President Joe Biden’s recent diagnosis of aggressive, advanced prostate cancer has brought global attention to the disease and its impact on men’s health. In India, prostate cancer is fast becoming a major concern, though awareness remains alarmingly low, warns Dr. Ramesh Sarin, Senior Consultant, Surgical Oncology, who has over three decades of experience in cancer treatment.

“We’re all aware about breast, liver, lung, throat and thyroid cancers but we don’t know as much about the other cancers which are major concerns in India, pancreatic, blood, prostate, ovarian (cancers) .. even though India is not among the countries with the highest risk for prostate cancers, it is increasing in our country and can be a cause for worry,” Dr. Sarin told First Check. 

Prostate cancer, according to Dr Sarin, “is now the third most common cancer among Indian men, and one of the top five leading causes of cancer mortality.” 

“Each year we see an increase in cases, major cause being ageing and poor lifestyle, also most cases are diagnosed at advanced stages due to limited screening and awareness,” the oncologist said. “Early prostate cancer is often silent. Symptoms like difficulty urinating, frequent urination at night, blood in urine, or pelvic discomfort should prompt a check-up. We recommend screening for men over 50, or over 45 with a family history.”

Gleason score: Prostrate cancer metric

Responding to the question about Biden’s reported Gleason score of 9, Dr Sarin explained how this scoring system is used to assess the aggressiveness of prostate cancer. “The diagnosis starts with a digital rectal exam and blood tests. If there’s suspicion, we perform a prostate biopsy. The tissue is then examined under a microscope, and this is where the Gleason score comes in,” she said.

The Gleason score, she further said, is a grading system based on how prostate cancer cells look under the microscope. 

“It informs how aggressive the cancer is. In India, we use the Gleason scoring system routinely, just like in the West. The pathologist assigns two grades (from 1 to 5) to the most common patterns seen in the biopsy. These are added to give a score between 2 and 10,” Dr Sarin said.

“A score of 6 or less is considered low-grade, slow-growing cancer. A score of 7 is intermediate, with moderate risk. Scores of 8 to 10 are high-grade, aggressive cancers more likely to spread,” she added. 

Also read: FACT CHECK: Does frequent ejaculation reduce prostate cancer risk? – First Check