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Introduction
Prostate cancer is the most frequently diagnosed cancer in men worldwide and the second leading cause of cancer-related mortality in the U.S. [1, 2]. The World Health Organization (WHO) reported 1.4 million new cases and 375,000 deaths from prostate cancer globally in 2020 [3]. Incidence rates and risk factors vary significantly across populations, with the highest rates observed in the U.S [4]. Notably, Asian men migrating to Western countries experience an increased risk, highlighting the complex interaction of genetic predispositions, such as inherited mutations in specific genes like BRCA1 and BRCA2, which significantly increase the likelihood of developing aggressive forms of prostate cancer, environmental exposures, and lifestyle factors [5, 6–7].
Prostate cancer is a significant health issue in Indonesia. According to GLOBOCAN 2020, it accounted for 7.3% of all new cancer cases in men worldwide [3]. In 2022, Indonesia reported 13,130 new cases, making it the fifth most common cancer among men, with 4860 deaths [8]. The prevalence rate in Indonesia was 23.5 per 100,000 people [8]. This highlights the rising burden of prostate cancer, emphasizing the need for further research and intervention in Indonesia. However, more recent data, particularly from 2023–2024, remains limited, underscoring the need for updated research to better address the growing impact of the disease.
Prostate cancer arises from a combination of direct and indirect factors. Direct causes include inherited genetic mutations such as BRCA1 and BRCA2, which are associated with a higher risk of aggressive prostate cancer [9, 10–11], while indirect factors include age, ethnicity, family history, and lifestyle choices [12, 13]. Though primarily diagnosed in older men, 10% of cases in the U.S. occur in those under 55 [14, 15]. Clinical symptoms can range from being asymptomatic to urinary issues, pelvic pain, and bone pain in advanced stages [16, 17]. Although prostate cancer predominantly affects older men, younger males can present with more aggressive disease, often resulting in poorer prognoses due to delayed diagnosis [16, 18]. Gross pathological features typically include nodular, firm masses within the peripheral zone of the prostate gland [19]. In advanced stages, these masses may show extracapsular extension and invasion of the seminal vesicles [20, 21]. Histological examination, typically using the Gleason grading system, assesses tumor aggressiveness based on glandular differentiation and cytological atypia...