Navigating Prostate Health: BPH, Early Cancer Detection, and Strategic Care After 50

Hyderabad, September 11th 2026:

In a detailed discussion on men’s health, Dr. C. Mallikarjuna, Chief Urologist and Managing Director at the Asian Institute of Nephrology and Urology (AINU), breaks down the complexities of prostate care. He addresses common patient demographics, the distinct differences between benign enlargement and prostate cancer, age-appropriate screening strategies, and how individual lifespan dictates treatment decisions.

Q1: What broad patient trends are you currently observing when men present for prostate health evaluations?

Dr. C. Mallikarjuna: Broadly speaking, we see three types of patients today:

 * The Symptomatic Patient: Men who experience urinary symptoms, recognize they might be related to the prostate, and seek direct medical treatment.

 * The Incidental BPH Patient: Men undergoing routine health checkups who are found to have an enlarged prostate (Benign Prostatic Hyperplasia). They often panic and demand immediate treatment out of fear of future complications, even if they currently lack symptoms.

 * The PSA-Screened Patient: A large group getting Prostate-Specific Antigen (PSA) blood tests—either through routine checkups or family advice. Whether their results are normal or abnormal, it frequently triggers an unnecessary scenario of panic.

It is vital for the general public to understand these presentation types so they can make informed decisions rather than reactive ones.

Q2: How prevalent are prostate conditions as men age, and what percentage actually require medical intervention?

Dr. C. Mallikarjuna: After the age of 50, prostate enlargement affects nearly every man to some degree. About 25% of men over 50 will experience noticeable symptoms related to this enlargement. However, only around 5% to 10% of them will ultimately require active medical treatment or surgical intervention. Given our aging population, that still represents a significant volume of patients who need proper management.

Q3: How common is prostate cancer in older men, and does every detected case cause symptoms or require immediate treatment?

Dr. C. Mallikarjuna: Statistically, about 75% of men over the age of 75 will harbor microscopic foci of prostate cancer. However, roughly 80% of these cases remain indolent—meaning they cause no symptoms and will never manifest clinical problems during the patient’s lifetime.

The remaining 20% will develop active symptoms and potentially suffer from the disease. Effectively, any man over 70 has about a 15% probability of facing clinically significant prostate cancer. The key is identifying who belongs to that vulnerable 20% before the disease reaches an advanced stage.

Q4: You often frame prostate issues using a generational lens. How should patients differentiate between a “father’s problem” and a “grandfather’s problem”?

Dr. C. Mallikarjuna: We need to clearly separate benign enlargement from prostate cancer:

 * The “Father’s Problem” (Around Age 50): This is typically Benign Prostatic Hyperplasia (BPH). It causes urinary flow obstruction, is non-cancerous, and can be managed with medications, minimally invasive therapies, or laser surgeries depending on severity.

 * The “Grandfather’s Problem” (Age 70+): This involves managing or screening for prostate cancer.

Patients must understand these are two entirely separate clinical entities. Treating a non-cancerous enlarged prostate does not manage cancer, and vice versa.

Q5: You use an eye analogy to explain how patients confuse normal test results with overall prostate health. Could you elaborate?

Dr. C. Mallikarjuna: A frequent misconception is that a normal PSA score means the entire prostate is completely healthy. Think of BPH and prostate cancer like your right and left eyes: treating or testing your right eye doesn’t tell you if your left eye is functioning properly. A normal PSA simply indicates a lower immediate probability of aggressive cancer; it does not mean you are exempt from benign structural enlargement that blocks urine flow. You need a distinct clinical evaluation for both conditions.

Q6: What is the optimal age window for early prostate cancer screening, and why does screening change after age 75?

Dr. C. Mallikarjuna: Early detection efforts aimed at finding asymptomatic prostate cancer should primarily take place before age 75.

If you detect early-stage, asymptomatic cancer at age 65 and treat it, you significantly reduce the 20% to 40% risk of that patient becoming symptomatic and dying before age 85. However, if you detect an early, slow-growing cancer in a 75-year-old, early treatment offers minimal gain because his natural lifespan expectancy may be around 10 years, during which the disease might never bother him. Beyond age 75, we transition from proactive early screening to diagnosing and treating patients only when they actually present with symptoms.

Q7: What is the oldest patient you have operated on for prostate cancer, and what guided that decision?

Dr. C. Mallikarjuna: The oldest patient I operated on for localized prostate cancer was 83 years old. Normally, we only offer radical surgery if a patient has at least a 10-year life expectancy.

Initially, I advised against surgery due to his age. However, the patient pointed out his family longevity—his father lived to 104, his mother to 101, and he had no major comorbidities besides mild hypertension. He argued he had a strong 20-year expectation ahead of him. We proceeded with the surgery; it has been 8 years now, and he remains alive and doing well. In elderly patients without symptoms, treatment choices must be carefully weighed against individual life expectancy.

Q8: Are there specific high-risk factors, such as family history, that dictate when a man should begin PSA testing?

Dr. C. Mallikarjuna: Yes, genetic predisposition plays a significant role. Family histories involving prostate cancer, breast cancer, colonic cancer, pancreatic cancer, or ovarian cancer increase an individual’s overall risk profile. If a man has a strong family history of these malignancies, he should actively initiate PSA testing and clinical evaluations in his 60s—or even earlier under direct specialist guidance.