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
Left untreated, BPH can lead to urinary retention (requiring emergency catheterisation), urinary tract infections, bladder stones, and — over time — kidney damage. These symptoms should never be normalised as “just ageing.”
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.
- 3× – Increase in crude incidence rate from 2005 to 2019 (3.1 → 9.5 per 100,000)
- 8.9% – Average annual percentage increase in age-standardised rate over 14 years
- ~60% – of patients already had metastases at the time of diagnosis
- 2% – of diagnosed patients were identified through screening — the rest presented with symptoms
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
Benign Prostatic Hyperplasia (BPH)
- Non-cancerous enlargement
- Very common after age 50
- Causes urinary obstruction symptoms
- Managed with medication or TURP surgery
- Does not spread to other organs
Prostate Cancer
- Malignant — can spread if untreated
- Often silent in early stages
- Detected via PSA test and DRE
- Requires specialist staging and treatment
- Outcomes vastly better with early detection
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.
Services available at the Hemas Urology Care Centre
- Prostate Cancer Management including androgen deprivation therapy and referral pathways for radiation
- TURP for enlarged prostate (BPH)
- Flexible Cystoscopy for diagnostic evaluation
- Personalised treatment planning based on each patient’s clinical profile
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.
Book a Urology Consultation Today
Early detection saves lives. If you are over 50, or have symptoms or a family history of prostate conditions, speak to our specialist team today.
References
- Pang KH, et al. Tracking and analysis of benign prostatic hyperplasia and prostate cancer burden globally: 1990–2021 epidemiological trends. PMC. 2024. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11986528/
- Sung H, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates. CA Cancer J Clin. 2021;71(3):209–249. doi:10.3322/caac.21660
- IARC/WHO. GLOBOCAN 2022: Cancer Incidence in Sri Lanka. Available at: https://gco.iarc.who.int/…
- Balagobi B, et al. The rising trend of prostate cancer: where does Sri Lanka stand? Journal of the College of Community Physicians of Sri Lanka. 2022. doi:10.4038/jccpsl.v27i5.8434
- Abeygunasekera AM, et al. Clinicopathological characteristics and primary treatment of prostate cancer in a urology unit of Sri Lanka. Journal of Cancer Research and Therapeutics. 2015. PMID: 26881518
- Hemas Hospitals Wattala. Urology Care Centre. Available at: https://hemashospitals.com/services/wattala/urology-care-centre/. Accessed April 2026.