As Telangana projects over 21,000 new male cancer cases by 2026, oncologists warn that cultural stigma, diagnostic inertia, and lifestyle shifts are driving the city towards a preventable crisis, Rashmi Kumari of Neo Science Hub reports

Prostate cancer cases are surging in Hyderabad, with many men diagnosed at advanced stages due to alarmingly low screening rates and unhealthy lifestyles, health experts have warned. The numbers carry a stark message: a disease that is highly treatable in its early stages is being allowed to reach its most lethal form simply because men are not getting tested.

Data from Nizam’s Institute of Medical Sciences (NIMS) shows that prostate cancer now accounts for 6.9 per cent of all male cancers in the city. By 2026, Telangana is projected to see over 21,252 new cancer cases among men, yet screening levels remain below four per cent — a figure that public health advocates describe as not merely inadequate, but dangerous.

The Scale of the Problem

India’s national picture mirrors what Hyderabad is experiencing in concentrated form. The National Cancer Registry Programme (NCRP) now projects prostate cancer to be the third most common cancer among Indian males, with an estimated age-adjusted incidence rate of 6.8 per 100,000 and a cumulative risk of 1 in 125 men. National case projections indicate the burden could reach approximately 47,000 new cases annually by 2025.

Globally, prostate cancer is the second most commonly diagnosed cancer in men and the fifth leading cause of cancer-related male mortality. From 1990 to 2019, global incidence rose by over 116 per cent, and the trend shows no signs of reversing. India ranks among the top ten countries worldwide by incidence, with an age-standardised rate of 5.6 per 100,000 — and projections suggest the figure will climb to 9.15 per 100,000 by 2031, according to Global Burden of Disease modelling.

Southern India has historically reported higher incidence rates than other regions, and urban registries in Delhi, Bengaluru, Mumbai, and Chennai have all recorded statistically significant annual increases. Delhi’s annual percentage change stands at 3.3 per cent; Chennai’s at 4.2 per cent. Hyderabad, as one of the country’s fastest-growing metropolitan centres, sits squarely within this high-risk urban corridor.

Key Statistics at a Glance

Indicator	India	Hyderabad / Telangana
Prostate cancer rank among male cancers	3rd most common (NCRP, 2022)	6.9% of all male cancers (NIMS)
Age-adjusted incidence rate	6.8 per 100,000 (2022)	Higher than national avg in S. India
Projected new cases by 2025	~47,068 annually	21,252+ (Telangana, 2026)
% diagnosed at metastatic stage	~43%	>50% in clinical estimates
Screening coverage	<5% overall	<4%
Stage IV fatality rate	~65%	~65%
5-year survival (all stages)	~64%	Mirrors national figure

Sources: NIMS Hyderabad, NCRP/ICMR, Global Burden of Disease Study 2021, Apollo Hospitals.

Late Diagnosis: A Preventable Tragedy

The most alarming finding in Hyderabad’s clinical data is not the incidence rate — it is the stage at which patients are presenting. A large proportion of men arrive at hospitals in Stage IV, where cancer has already spread beyond the prostate to other organs. National data from Hospital-Based Cancer Registries shows that approximately 43 per cent of all prostate cancer cases in India are diagnosed at the distant metastatic stage. In Hyderabad, clinical estimates suggest the figure may be even higher.

At Stage IV, survival rates drop precipitously. National figures indicate a 65 per cent fatality rate at this advanced stage, compared to a far more favourable prognosis for localised disease. Apollo Hospitals data indicates that India’s overall five-year survival rate for prostate cancer stands at approximately 64 per cent across all stages — a figure that could be dramatically improved with earlier detection. Men who undergo surgery for localised prostate cancer have demonstrated 15-year survival rates exceeding 91 per cent.

The reasons for late diagnosis are multiple. Early symptoms — frequent urination, a weakening urine stream, difficulty initiating urination, or vague pelvic discomfort — are routinely attributed to the normal aging process. Cultural attitudes reinforce this: many Indian men, particularly those above 60, are reluctant to discuss urological symptoms or submit to a rectal examination, which remains a key component of screening protocols.

“Prostate cancer is not always aggressive at first, offering a clear window for life-saving detection.”
— Dr Nikhil Suresh Ghadyalpatil, Director of Medical Oncology, Apollo Health City, Jubilee Hills

Dr Ghadyalpatil urged that prostate cancer screening be integrated into routine health check-ups for men above 50, rather than treated as a specialised investigation sought only in response to symptoms. The logic is straightforward: by the time symptoms become conspicuous, the disease is often no longer localised.

Risk Factors: Age, Lifestyle and the Urban Transition

Age remains the single most significant non-modifiable risk factor. Prostate cancer is exceptionally rare in men below 40, but the risk increases sharply after 50 and accelerates further after 64. With India’s male population above 50 now numbering approximately 9.8 crore, and life expectancy having extended to around 70 years, the demographic foundation for a sustained rise in cases is firmly in place.

Family history constitutes another major risk category. Men with a first-degree relative — father or brother — diagnosed with prostate cancer face a substantially elevated risk. Certain genetic mutations, including those in the BRCA1 and BRCA2 genes, are now recognised as conferring higher lifetime risk and more aggressive disease behaviour. Genomic testing for these variants is increasingly integrated into care protocols at major oncology centres globally, though its reach in India remains limited to tertiary institutions.

Lifestyle factors are where the urban story of Hyderabad becomes particularly relevant. The city’s rapid economic growth has brought with it a dietary transition — higher consumption of processed foods, red meat, and high-fat dairy products; reduced physical activity; rising rates of obesity and type 2 diabetes. Doctors point to these as key drivers behind the increase. Smoking and excessive alcohol consumption add further to the risk profile. Hyderabad’s lifetime cancer risk stands at one in eight for those aged 0 to 74, mirroring a national crisis in which cancer deaths could approach 705,000 by 2026.

One emerging concern, still under investigation, relates to testosterone replacement therapy (TRT), whose uptake among older men has grown substantially in urban India. While the causal link to prostate cancer remains contested in the literature, clinicians advise careful monitoring of PSA levels in men on TRT.

Screening: What Exists, What Is Used, and What Is Not

The primary tool for prostate cancer screening is the Prostate-Specific Antigen (PSA) blood test, a straightforward laboratory investigation that measures the concentration of a protein secreted by the prostate gland. Elevated PSA levels do not in themselves confirm cancer — they can also indicate benign prostatic hyperplasia (BPH) or prostatitis — but they serve as a critical red flag prompting further evaluation. A Digital Rectal Examination (DRE), in which a physician manually assesses the prostate’s size, texture, and any irregularities, is typically conducted alongside a PSA test.

When these initial screens raise concern, the diagnostic pathway advances to transrectal ultrasound (TRUS), multiparametric MRI, and ultimately a biopsy for histological confirmation. More recently, PSMA PET scans have emerged as powerful tools for staging and detecting recurrence, and MRI-fusion guided biopsies offer improved accuracy in detecting clinically significant disease while reducing unnecessary biopsies.

Despite the availability and relative affordability of the PSA test, systematic screening in Hyderabad — as across India — is almost non-existent at the primary care level. Screening rates below four per cent reflect a system in which prostate cancer investigation is initiated reactively, upon complaint, rather than proactively, through scheduled health maintenance. The Indian Cancer Society and the Ministry of Health have begun promoting awareness, and a growing number of corporate hospitals now include PSA testing in annual executive health packages, but penetration remains thin outside affluent urban demographics.

A senior NIMS oncologist, speaking on condition of anonymity, emphasised that community awareness drives and integration with primary care facilities are the missing links. “We need to reach men where they are — in their neighbourhoods, through their family physicians, through workplace health programmes. A PSA test costs very little. The cost of not doing it is measured in lives,” the oncologist said.

Treatment: The Expanding Arsenal

For men whose disease is detected early, the treatment landscape is significantly encouraging. Localised prostate cancer (Stages I and II) is addressed through surgery — radical prostatectomy, including robot-assisted minimally invasive procedures — or radiation therapy, including external beam radiotherapy and brachytherapy. Active surveillance, where low-risk tumours are monitored rather than immediately treated, is an increasingly accepted approach that helps men avoid over-treatment.

India’s prostate cancer treatment market reflects this expanding therapeutic landscape. Valued at approximately $13.2 billion in 2024, it is projected to reach $28 billion by 2033, growing at a compound annual rate of 8.8 per cent. Advanced technologies including robotic surgery, High Intensity Focused Ultrasound (HIFU), Image-Guided Radiation Therapy (IGRT), and targeted hormonal therapies are gaining traction in Hyderabad’s top-tier oncology centres, including Apollo Health City, Yashoda Hospitals, and NIMS.

For locally advanced disease (Stage III), surgery or radiation is combined with hormonal therapy — designed to suppress testosterone, which fuels tumour growth. At Stage IV, hormone therapy remains the cornerstone, supplemented by chemotherapy, immunotherapy, and newer agents targeting specific molecular pathways. Castration-resistant prostate cancer, where the disease progresses despite testosterone suppression, remains a significant clinical challenge, and research into next-generation treatments is actively ongoing.

Prevention, Awareness, and Policy

Experts across disciplines converge on a consistent prescription: the key to reducing Hyderabad’s prostate cancer burden is not more advanced treatment at late stages, but earlier detection through structured screening, and prevention through lifestyle modification.

The clinical recommendations are specific. Men above 50 should discuss PSA testing with their physicians annually. Men with a family history of prostate cancer, or of BRCA-related cancers, should consider beginning that conversation at 45. Dietary changes — increased consumption of vegetables including cruciferous varieties such as broccoli and cauliflower, reduction in processed meats and saturated fats, and maintenance of a healthy body weight — can collectively reduce risk. Regular aerobic exercise improves metabolic health and reduces several cancer-associated inflammatory markers.

At the systemic level, public health campaigns need to address the specific cultural barriers that prevent men from seeking help. Health literacy on prostate cancer remains far lower than on conditions such as diabetes or heart disease. The government’s National Programme for Non-Communicable Diseases (NP-NCD) offers a framework, but its integration of prostate cancer screening at the urban primary health centre level is yet to be systematically implemented.

Hyderabad’s lifetime cancer risk of one in eight makes it impossible to treat this as a marginal issue. With the right infrastructure, awareness, and political will, thousands of Stage IV diagnoses — each representing a family shattered by preventable mortality — could be shifted to Stage I detections, where cure rates are high and treatment costs are far lower.

“We need community awareness drives and primary care integration to catch this early.”
— Senior Oncologist, NIMS Hyderabad (speaking anonymously)

The message from Hyderabad’s oncology community is unambiguous: the window for action is open. Prostate cancer, unlike many malignancies, gives men time — if only they choose to use it.

KNOW YOUR RISK: WHEN TO GET SCREENED
Age 50 and above: Discuss PSA testing with your physician annually. Age 45 and above (if family history of prostate cancer or BRCA-linked cancers): Begin screening conversations earlier. Watch for early symptoms: frequent or difficult urination, weak urine flow, blood in urine or semen, pelvic discomfort. Do not dismiss these as ageing. Key tests: PSA blood test, Digital Rectal Examination (DRE), and if flagged, multiparametric MRI or biopsy. Lifestyle: Maintain healthy weight, eat more vegetables, reduce processed meat and saturated fat, exercise regularly.