Prostate Cancer — Symptoms, Diagnosis, and Treatment in Hyderabad
Prostate cancer is the most common cancer in men after skin cancer globally, and increasingly prevalent in Indian men with incidence rising as the population ages and PSA screening becomes more widely adopted. In Telangana and Andhra Pradesh, prostate cancer is among the three most common male cancers presenting at tertiary urology centres. The good news and it is significant is that prostate cancer is one of the most curable of all cancers when detected early. Localised prostate cancer treated with definitive therapy (surgery or radiation) has a 10-year cancer-specific survival exceeding 95% in most series. The challenge is that prostate cancer is usually silent until it has grown substantially, making PSA screening in men above 50 the most important prostate cancer intervention available.
Treatment decisions in prostate cancer are genuinely complex far more so than in most solid tumours. A man with localised prostate cancer may be appropriately managed with active surveillance (no immediate treatment, monitoring with regular PSA and biopsies), radiation therapy, robotic surgery (RARP), or at KIMS, the only centre in India — TULSA-PRO (MRI-guided ultrasound ablation). The right choice depends on the grade and stage of the cancer, the patient's age and overall health, their priorities regarding urinary function, sexual function, and quality of life, and the specific technical characteristics of the tumour on MRI.
This post explains what prostate cancer is, how it is detected, how it is staged, and what the treatment options look like at KIMS Secunderabad with an honest explanation of what each option offers and what it trades off.
What is prostate cancer?
The prostate gland produces fluid that forms part of semen. It is located immediately below the bladder and surrounds the urethra. Prostate cancer develops when cells in the prostate's glandular tissue undergo malignant transformation and begin to multiply uncontrollably. Most prostate cancers arise in the peripheral zone of the prostate the outer part of the gland which explains why they often cause no urinary symptoms until they are large enough to invade the urethra or bladder neck.
Prostate cancer is histologically graded using the Gleason score (now reported as the ISUP Grade Group) a measure of how abnormal the cancer cells look under the microscope and how aggressively they are likely to behave. Grade Group 1 (Gleason 6) tumours are slow-growing and often managed with active surveillance. Grade Group 5 (Gleason 9 to 10) tumours are highly aggressive and require immediate definitive treatment. The grade, combined with the clinical stage (is the cancer confined to the prostate or has it spread?) and the PSA level, determines the risk category and treatment recommendation.
PSA screening — who should be tested and when
PSA (Prostate Specific Antigen) is a protein produced by prostate cells both normal and cancerous. An elevated PSA does not diagnose prostate cancer (BPH, prostatitis, and prostate trauma also raise PSA), but it triggers further investigation that leads to diagnosis. The value of PSA screening is that it detects cancer before symptoms develop at a stage when curative treatment is most effective.
Men aged 50 to 70 with average risk
Annual PSA test from age 50
Men with a first-degree relative
Father or brother who had prostate cancer — annual PSA from age 45
Men of African descent
Annual PSA from age 45 (higher inherent risk)
PSA interpretation & Density
A PSA density (PSA divided by prostate volume in ml, measured by ultrasound or MRI) above 0.15 ng/ml/ml is considered elevated, regardless of the absolute PSA value. PSA velocity (rate of rise year-on-year) is also relevant — a rise of more than 0.75 ng/ml per year warrants investigation.
At KIMS, PSA measurement is offered to all men above 50 presenting for any urology consultation, and results are interpreted in context not simply against a single PSA threshold. A PSA of 4 in a man with a 100cc prostate (PSA density 0.04) is very different from a PSA of 4 in a man with a 15cc prostate (PSA density 0.27). The KIMS urologist contextualises PSA results with prostate volume, age, and family history before recommending further investigation.
Diagnosis — from PSA to biopsy to staging
Multiparametric MRI (mpMRI)
When PSA raises suspicion, the next step at KIMS is mpMRI. It identifies suspicious lesions using T2-weighted, diffusion-weighted, and dynamic contrast imaging — graded on the PI-RADS scale (1 to 5). PI-RADS 4 and 5 lesions are almost always biopsied, while PI-RADS 1 and 2 may be safely monitored. This reduces unnecessary biopsies and targets the needle to the most suspicious area.
MRI-Targeted Fusion Biopsy
Using MRI findings to guide needle placement — either as MRI-targeted systematic biopsy or fusion biopsy (where MRI and ultrasound images are fused in real-time). Multiple cores are taken from suspicious and systematic zones, then analysed by our NABL-accredited pathology laboratory to report Gleason grade and percentage core involvement.
Clinical Staging & Imaging
Once confirmed, staging determines spread: PSA and Gleason Grade determine the risk category (Low to Very High). Intermediate and high-risk cases undergo Bone scans (to exclude metastases) and CT scans of the abdomen/pelvis. PSMA PET-CT—the most sensitive imaging for prostate cancer—is used for high-risk or biochemically recurrent disease.
Treatment options for prostate cancer at KIMS
Treatment decisions in prostate cancer are genuinely complex. The right choice depends on the grade and stage of the cancer, the patient's age and overall health, and their priorities regarding quality of life. At KIMS, we offer the full spectrum of modern interventions:
Active surveillance — for very low and low-risk localised prostate cancer
Not all prostate cancers need immediate treatment. Grade Group 1 (Gleason 6) cancers that are limited to the prostate, with PSA below 10 and low volume on biopsy, can be safely monitored with active surveillance — PSA every 3 to 6 months, repeat MRI at 12 to 18 months, and confirmatory biopsy at 1 to 2 years. Active surveillance is not watchful waiting — it is systematic monitoring that intervenes with definitive treatment if the cancer progresses. At KIMS, active surveillance decisions are made at multidisciplinary tumour board review, and the surveillance schedule is rigorously maintained.
Robotic Radical Prostatectomy (RARP) — surgical removal of the prostate
RARP — robotic-assisted laparoscopic radical prostatectomy — is the surgical removal of the entire prostate gland using the Da Vinci robotic platform. At KIMS, RARP is performed using both the Da Vinci Xi and Da Vinci X — the two most advanced robotic platforms available. Dr. Likhiteswer Pallagani, who leads the KIMS robotic surgery programme, brings 400+ robotic procedures and a Vattikuti Foundation Fellowship in Uro-Oncology and Robotic Surgery to every case. The Da Vinci robot provides 10x magnified 3D vision, 7 degrees of instrument freedom, and tremor elimination. Critically, this precision enables nerve-sparing surgery: the preservation of the neurovascular bundles that control erectile function. RARP at KIMS involves 3 to 4 small keyhole incisions (each <1cm), 2 to 3 nights in hospital, catheter removal at 7 days, and full recovery at 4 to 6 weeks.
TULSA-PRO — MRI-guided ultrasound ablation (India's only centre)
For selected men with localised prostate cancer — particularly those in the intermediate-risk category who wish to avoid surgery and radiation — TULSA-PRO (Transurethral Ultrasound Ablation) offers an incision-free treatment option available in India only at KIMS Secunderabad. A thin probe is placed through the urethra under MRI guidance. Focused ultrasound energy ablates the cancer-bearing tissue while real-time MRI thermometry monitors the treatment zone with millimetre precision. Outcomes include a 95% PSA reduction at 1 year and preservation of urinary/sexual function significantly better than surgery or radiation. It is a same-day or next-morning discharge procedure.
Radiation therapy & Hormone Therapy (ADT)
External beam radiotherapy (EBRT) — delivered via linear accelerator using IMRT (intensity-modulated radiotherapy) and IGRT (image-guided radiotherapy) — and brachytherapy (radioactive seed implantation) are established alternatives to surgery. Radiation therapy at KIMS is coordinated with the oncology team as part of the multidisciplinary programme. For high-risk localised and locally advanced prostate cancer, radiation combined with androgen deprivation therapy (ADT — hormone therapy) is the standard of care when surgery is not the chosen approach.
Multidisciplinary tumour board review — every prostate cancer case at KIMS
At KIMS, every prostate cancer case is reviewed at the multidisciplinary tumour board (MDT) a formal meeting of urological oncologists, radiation oncologists, medical oncologists, radiologists, and pathologists — before any treatment recommendation is finalised. This means the patient's treatment plan reflects the collective expertise of specialists across all treatment modalities, not the default preference of a single surgeon or specialty. The MDT recommendation is the basis for the treatment discussion with the patient at the post-MDT consultation.
Frequently Asked Questions — Prostate Cancer
Prostate cancer rarely causes symptoms in its early and most treatable stages which is precisely why PSA screening matters. When symptoms do occur, they typically reflect either local tumour growth into the urethra or bladder neck (causing urinary symptoms similar to BPH weak stream, frequency, urgency) or advanced disease with spread to bones (bone pain, particularly in the lower back, hips, or pelvis). The first sign of prostate cancer in most diagnosed cases is an elevated PSA on a routine blood test not a symptom. Any man above 50 with an elevated PSA on routine testing should be seen by a urologist even in the complete absence of urinary symptoms.
Yes — localised prostate cancer (cancer confined to the prostate gland) is curable with definitive treatment in the vast majority of cases. The 10-year cancer-specific survival for localised prostate cancer treated with RARP or radiation therapy exceeds 95% in most series. Even intermediate-risk and some high-risk localised cancers achieve long-term remission with appropriate treatment. Metastatic prostate cancer — cancer that has spread to lymph nodes or bones is not currently curable, but is manageable for years or even decades with androgen deprivation therapy, docetaxel or cabazitaxel chemotherapy, and newer targeted agents such as abiraterone and enzalutamide. Early detection while the cancer is still localised is the most effective route to cure.
Open radical prostatectomy requires a 10 to 15cm incision in the lower abdomen, direct manual access to the prostate, and typically 5 to 7 days in hospital with significant blood loss and a 6 to 8 week recovery. RARP (Robotic Assisted Radical Prostatectomy) uses 3 to 4 keyhole incisions of less than 1cm each, the Da Vinci robotic platform's 10x magnified 3D vision and 7-degree instrument freedom, a hospital stay of 2 to 3 nights, and a recovery of 3 to 4 weeks. Critically, robotic nerve-sparing is more precise than open nerve-sparing the magnified view and tremor-filtered instruments allow the surgeon to dissect the neurovascular bundles away from the prostate with a precision that open surgery cannot replicate, improving erectile function recovery rates.
TULSA-PRO (Transurethral Ultrasound Ablation) is an MRI-guided, incision-free prostate cancer and BPH treatment where focused ultrasound energy ablates prostate tissue through a thin transurethral probe under real-time MRI thermometry guidance. It is approved by the FDA (USA) and CE marked (Europe). In India, KIMS Secunderabad is the first and only centre to offer TULSA-PRO — no other hospital in India has this technology. TULSA-PRO is particularly suited to men with localised prostate cancer who wish to avoid surgery and radiation, and who prioritise preservation of urinary and sexual function. Same-day or next-morning discharge. Contact KIMS on 040 - 44885000 for a TULSA-PRO eligibility assessment.
Erectile dysfunction is a potential consequence of radical prostatectomy the neurovascular bundles controlling erection run alongside the prostate and must be carefully preserved during surgery. At KIMS, nerve-sparing RARP is performed when the cancer's location and grade allow the 10x magnified 3D view and 7-degree instrument freedom of the Da Vinci robot makes nerve-sparing more precise than open surgery. Erectile function recovery is related to the patient's pre-operative function, age, and whether nerve-sparing was achievable. Most men with good pre-operative function who undergo bilateral nerve-sparing RARP recover erectile function within 12 to 24 months, with pharmacological support (PDE5 inhibitors) in the interim. TULSA-PRO has a significantly better sexual function preservation profile than surgery.
PSA (Prostate Specific Antigen) is a protein produced by prostate cells, measurable in the blood. There is no single 'normal' PSA value — PSA increases with age and prostate size. A PSA of 3 ng/ml in a 50-year-old man with a small prostate warrants different concern than the same PSA in a 70-year-old with a large benign prostate. The PSA density (PSA divided by prostate volume) and PSA velocity (rate of rise year-on-year) provide more meaningful context than the absolute PSA value alone. At KIMS, PSA results are interpreted in context not against a single threshold with mpMRI and clinical assessment guiding the decision to biopsy.
KIMS Secunderabad — India's only TULSA-PRO centre (MRI-guided incision-free prostate cancer treatment), Da Vinci Xi AND X robotic platforms for RARP (nerve-sparing, 10x magnified precision), Dr. Likhiteswer Pallagani with 400+ robotic surgeries and Vattikuti Foundation fellowship in uro-oncology, multidisciplinary tumour board review of every case, NABH and NABL accredited. Call 040 - 44885000.