Men’s health conversations in Sri Lanka have traditionally been shaped by silence. Prostate conditions — whether benign or malignant — are often dismissed as an inevitable part of ageing, left unaddressed until symptoms become unbearable. Yet the data tells a story that demands urgent attention: prostate cancer rates in Sri Lanka have nearly tripled over the past 14 years, and millions of men are quietly suffering from an enlarged prostate that significantly impacts their daily quality of life.

Understanding the Prostate

The prostate is a small, walnut-sized gland that sits just below the bladder and surrounds the urethra — the tube through which urine and semen exit the body. Its primary role is to produce seminal fluid that nourishes and transports sperm. As men age, the prostate is susceptible to two main conditions: non-cancerous enlargement (BPH) and cancer. Both can significantly affect urinary function and overall wellbeing, but they are very different in nature and management.

Benign Prostatic Hyperplasia (BPH): The Enlarged Prostate

BPH is extraordinarily common. A comprehensive global meta-analysis found that the lifetime prevalence of BPH is approximately 26.2% across all ages. Among men over 50, clinical prevalence ranges from 50% to 75% — and among men over 70, it exceeds 80%.

In BPH, the prostate tissue grows and presses against the urethra, obstructing the flow of urine. The result is a cluster of symptoms collectively known as Lower Urinary Tract Symptoms (LUTS):

• Difficulty starting urination or a weak urine stream
• Frequent need to urinate, particularly at night (nocturia)
• A feeling of incomplete bladder emptying
• Dribbling at the end of urination
• Urgency — a sudden, strong urge to urinate

Treatment options for BPH range from lifestyle modifications and medication to a surgical procedure called Transurethral Resection of the Prostate (TURP), where excess prostate tissue is removed using a resectoscope inserted through the urethra — a well-established procedure with excellent outcomes.

Prostate Cancer: A Rising Threat in Sri Lanka

Prostate cancer is globally the second most common cancer in men. In Sri Lanka, it ranks as the fifth most common cancer among men, with approximately 1,019 new cases recorded in 2022 — representing 6.5% of all male cancers in the country.

This late detection is not inevitable — it is a consequence of low awareness, cultural reluctance to discuss symptoms, and the absence of routine screening programmes. The situation closely mirrors patterns seen in many developing countries where prostate cancer awareness remains insufficient.

Warning Signs You Should Never Ignore

Prostate cancer is often silent in its early stages. When symptoms do appear, they may include:

• Difficulty urinating or a decreased force in the urine stream
• Blood in the urine or semen
• Bone pain, particularly in the back, hips, or pelvis (which may indicate spread)
• Unexplained weight loss and fatigue
• Painful ejaculation

Symptoms of early prostate cancer often overlap with BPH — which is precisely why specialist evaluation is essential. A simple blood test (the Prostate Specific Antigen or PSA test) and a digital rectal examination (DRE) are the cornerstone of early detection.

BPH vs. Prostate Cancer: Key Differences at a Glance

Who Is at Risk?

Risk factors for prostate cancer include:

• Age: risk rises sharply after 50. In Sri Lanka, 76.8% of cases are diagnosed in men aged 65 and above
• Family history: having a first-degree relative with prostate cancer increases risk
• Diet: excessive red meat consumption, high-fat diets, and low vegetable intake are associated with increased risk
• Obesity and physical inactivity

Men with BPH symptoms, those aged over 50, or those with a family history of prostate cancer should discuss routine screening with a urologist.

Why Expert Urology Care Matters

Both BPH and prostate cancer require careful, expert evaluation. The two conditions can present similarly, and accurate diagnosis requires a combination of clinical examination, PSA testing, imaging, and in some cases, biopsy. Making the right diagnosis and the right treatment decision demands specialist knowledge.

With over a decade of experience, cutting-edge diagnostic technology, and a team of highly skilled urologists, the Hemas Urology Care Centre brings international standards of care to patients in the western province and beyond. As part of the ACHSI-accredited Hemas Hospitals network, patients benefit from the highest safety and quality standards available in Sri Lanka.

Prostate health is not something to put off. A conversation with a specialist could be the most important step you take this year.