[Health Byte] Men's Sexual Organs, and Cancer

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Nobody wants to talk about their prostate.

Urologists at Shanghai Yueyang Hospital have been watching middle-aged and older men shuffle into their clinic for years, guys who've been quietly waking up three times a night to pee, waiting ten seconds at the urinal for something to happen, dribbling when they finally do, and telling themselves this is just what getting older feels like. It isn't. Or rather, it doesn't have to be.

Prostate disease earned its reputation as a "silent hidden danger" precisely because the symptoms are so easy to rationalize away. Nocturia (waking at night to urinate, repeatedly), weak urine flow, and urinary hesitation (that frustrating pause before anything comes out) are not rites of passage. They are your body flagging something worth looking at.

The urology department at Yueyang has put together a guide that covers the whole spectrum: who's at high risk, what the warning signs actually look like, how PSA testing (a blood test that screens for prostate problems) is supposed to work, what integrated Chinese and Western treatment looks like in practice, what you can do at home, and what expats in Shanghai specifically need to know. They're also, usefully, in the business of correcting a set of myths about prostate health that have been circulating long enough to cause real damage.

All of that follows. Pay attention.

The Practical Guide to Prostate Cancer Prevention and Management

Prostate cancer is one of the most common cancers in men globally. Age, genetics, and how you've been living your life are the three factors that matter most.

Who Should Get Screened, and When

Five categories of men should be actively pursuing early screening rather than waiting for something to go wrong.

Men over 50, first of all. The risk curve bends sharply upward with age; by the time you're past 70, you're carrying dozens of times the risk of a 50-year-old. Men with a father or brother who had prostate cancer face two to three times the baseline risk. If your family has multiple cases, or anyone diagnosed before 60, move that screening start date up to 45.

Carriers of BRCA2 mutations (a genetic variant more commonly associated with breast cancer but also linked to aggressive prostate cancer) should be getting annual screening from 40, alongside a proper genetic risk evaluation. Men with long-term high-fat diets, central obesity (the kind that accumulates around the abdomen), heavy smoking habits, or serious alcohol consumption are also in elevated-risk territory. And men who already have benign prostatic hyperplasia (BPH, a non-cancerous enlargement of the prostate) with worsening symptoms need regular check-ups, because BPH and prostate cancer can coexist, and urinary symptoms alone won't tell you which one you're dealing with.

What "Something's Wrong" Actually Looks Like

Early prostate cancer is quiet. Inconveniently, suspiciously quiet. The symptoms that should send you to a doctor tend to emerge when the disease has already progressed, which is precisely why screening exists.

Watch for: a urine stream that keeps getting thinner, persistent straining to urinate, or the feeling that your bladder never fully empties, especially if standard BPH medication isn't helping anymore. Blood in the urine or semen, even without pain, is a flag. So is persistent, unprovoked pain in the lower back, hips, or bones, which can occasionally escalate to pathological fractures (bone breaks triggered by disease rather than impact). Rapid unexplained weight loss, sustained fatigue, anemia, and appetite loss in a short window also warrant immediate attention.

None of this is pleasant to read. That's the point.

A High PSA Is Not a Diagnosis

PSA (prostate-specific antigen) is a protein produced by the prostate, and elevated levels in a blood test signal that something may be worth investigating. They do not confirm cancer. This distinction matters enormously, because a lot of things can spike your PSA that have nothing to do with malignancy: prostatitis (prostate inflammation), BPH, a recent bike ride, a catheter, or even a digital rectal exam (a physical examination where a doctor checks the prostate through the rectum).

The protocol, done properly, looks like this. First, clear the interference: no cycling, no prostate massage, no sexual activity for three days before the blood draw. If there's an active urinary tract infection or prostatitis, treat that first and retest afterward.

If PSA comes back in the 4 to 10 ng/ml range, which doctors call the "gray zone" because it's ambiguous enough to require more work, the next step is calculating the free-to-total PSA ratio (a comparison of two PSA forms in the blood that helps distinguish cancer from benign causes) and PSA density (the PSA level divided by prostate volume, which accounts for the fact that a larger prostate naturally produces more PSA). A follow-up test two to four weeks later tracks whether the number is moving.

Only if PSA keeps climbing, the ratios look abnormal, or a physical exam detects a hard nodule does the doctor order an mp-MRI (multi-parametric MRI, an advanced imaging scan that maps the prostate in detail and scores suspicious areas by risk level). And only if that scan identifies a high-risk lesion does a biopsy become necessary: a tissue sample taken via the rectum and analyzed under a microscope to deliver an actual diagnosis.

Stepwise. Evidence-based. Not panicked.

What Yueyang Actually Does Differently

The pitch for integrated TCM and Western medicine gets made a lot in Shanghai. Yueyang's urology department is one of the places where it holds up under scrutiny.

The surgical capability is serious. Surgeons here perform transurethral laser prostatectomy (a minimally invasive procedure that uses laser energy to remove obstructive prostate tissue from the inside, without external incisions) and robot-assisted laparoscopic radical prostatectomy (surgery to remove the entire prostate, guided by a robotic system that allows for precision in an extremely confined anatomical space). What's less standard is the acupuncture anesthesia applied during these procedures, which in practice means lower doses of pharmaceutical anesthetic, fewer postoperative complications, and a faster recovery arc. Whether you find that remarkable or merely interesting probably depends on your priors about acupuncture, but the outcomes are what they are.

For men who aren't yet at the surgery stage, which is most men with slightly elevated PSA or early-stage BPH, the TCM approach kicks in earlier. Doctors assess each patient's constitution through TCM differentiation (a diagnostic framework that categorizes patients by symptom patterns and underlying imbalances rather than disease labels alone), then build a regimen that might combine syndrome-specific herbal formulas taken orally, acupoint application (herbal patches placed on specific points on the body to deliver therapeutic effect transdermally), and herbal sitz baths. The goal is to ease urinary symptoms and slow the progression of the disease before it demands more aggressive intervention.

Post-surgery rehabilitation is where the integration gets particularly granular. Men recovering from radical prostatectomy commonly deal with urinary incontinence (loss of bladder control) and pelvic discomfort, both of which Yueyang addresses with electroacupuncture (acupuncture with a small electrical current run between needles to intensify stimulation), moxibustion (the burning of dried mugwort near acupuncture points to generate therapeutic heat), and TCM-guided pelvic floor training. For patients going through endocrine therapy (hormone-suppressing treatment that starves prostate cancer of testosterone) or radiotherapy, custom herbal prescriptions target the side effects that make those treatments brutal: hot flashes, bone pain, sustained fatigue.

Long-term, the department maintains individual health files for BPH and post-surgery patients, with herbal plaster formulas, dietary plans, and exercise guidance built around each case. It's chronic disease management with more levers than a purely Western clinic would typically pull.

What You Can Do at Home

The dietary guidance here is not exotic. Tomatoes (lycopene, a plant pigment with antioxidant properties), green tea (tea polyphenols, compounds associated with reduced inflammation), soy products like black beans and soybean milk (phytoestrogens, plant-derived compounds that may help regulate hormone-sensitive tissues), broccoli, pomegranate, pumpkin, nuts. These are foods worth eating regardless of what your prostate is up to.

The limit list is equally unsurprising: red meat, high-fat fried food, spicy irritants, heavy alcohol, smoking. Chronic prostate congestion (persistent inflammation and blood pooling in the prostate, which can worsen symptoms) is aggravated by all of the above.

For men whose TCM constitution has been assessed, the dietary recommendations get more specific. Yang-deficiency types (characterized by frequent nocturia and cold intolerance, often described in TCM as a depletion of warming energy) are pointed toward walnuts and Chinese yam. Damp-heat constitutions (a pattern involving inflammation and fluid retention, often presenting as burning urination and a yellow, greasy coating on the tongue) benefit from winter melon and coix seed soup. Your TCM doctor will tell you which camp you're in.

On the exercise side: 150 minutes of moderate aerobic activity weekly, brisk walking, swimming, Tai Chi, all of which improve pelvic circulation and keep weight in check. Kegel exercises (voluntary contractions of the pelvic floor muscles, held for three to five seconds and released, ten to fifteen reps per set, three sets a day) strengthen the muscles that control urination and matter a great deal for men managing incontinence before or after surgery. And the simplest instruction of all: don't sit for more than an hour without getting up, and don't hold it when you need to go.

A Note for Expats

If you're a Western man living in Shanghai, here's a number worth sitting with: prostate cancer incidence among European and American men runs five to ten times higher than among Chinese men. The reasons are a combination of diet, genetics, and the fact that Western healthcare systems have historically screened for it more aggressively, which surfaces cases that might otherwise go undetected. Whatever the cause, the gap is real, and it means the risk profile you walked in with is not the same as your Chinese neighbors'.

Yueyang's recommendation for expats of European or American descent with any family history of prostate cancer: start annual PSA testing and digital rectal exams at 45, not 50. Five years earlier. The upside of catching something early is not subtle.

The practical barriers to healthcare in Shanghai are real, and Yueyang has addressed the obvious ones. English-speaking staff handle consultations, walk you through lab results, and build treatment plans that align with international clinical guidelines, so you're not navigating a system designed entirely around assumptions you don't share. For expats curious about or open to the TCM component, acupuncture and herbal conditioning are available to manage urinary discomfort and soften the side effects of Western treatments. Nobody is going to insist on it. But it's there.

Things That Are Not True, But Widely Believed

A few myths about prostate health have proven remarkably durable. They're worth dispatching clearly.

A high PSA means you have cancer. No. Around 70 percent of elevated PSA readings come from benign causes: BPH, prostatitis, recent physical activity, a rectal exam. PSA flags a risk level; it does not confirm a diagnosis. That's what the stepwise protocol described earlier is for.

BPH turns into prostate cancer if left untreated. Also no. BPH (benign prostatic hyperplasia, a non-cancerous enlargement of the prostate) and prostate cancer are biologically distinct conditions with different origins and different pathological properties. Hyperplasia does not transform into malignancy. The two can coexist in the same prostate, which is exactly why symptoms alone aren't enough to tell them apart, but one does not cause the other.

No symptoms means no problem. This one is genuinely dangerous. Early prostate cancer produces almost no discomfort. Blood in the urine and bone pain are late-stage signals. Regular PSA screening exists specifically because by the time you feel something, you've already lost the window where intervention is easiest.

All prostate problems are TCM kidney deficiency, fixable with tonic supplements. Prostate disorders and TCM kidney deficiency (a pattern in Chinese medicine describing a depletion of the body's foundational energy, often presenting as fatigue, lower back weakness, and urinary changes) are not interchangeable concepts. Self-prescribing aphrodisiac or kidney-tonifying supplements without a proper TCM assessment can worsen prostate congestion and disrupt androgen levels (the hormones, primarily testosterone, that influence prostate tissue). Get an actual diagnosis before reaching for the health products aisle.

Surgery is the only solution for BPH. Mild to moderate BPH responds well to lifestyle changes and medication. Surgery is reserved for severe complications: recurrent urinary retention (the inability to empty the bladder at all), hydronephrosis (a dangerous backup of urine causing kidney swelling), or repeated episodes of blood in the urine. If you're not at that threshold, you're not at the surgery conversation yet.

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About the Author

Cai Wenjun is a seasoned health reporter with Shanghai Daily. With extensive experience covering the local medical system, hospitals, health officials and leading medical experts, Cai has reported on major pandemics including SARS, swine flu and COVID-19, as well as developments in the local health industry.