--- title: Prostate cancer in South Korea: what the evidence says about who is found late, and what happens next publication: Medical Insights Korea section: news category: Prostate canonical_url: https://medicalinsightskorea.com/news/prostate-cancer-in-south-korea author: Andrew Cho published: 2026-09-08T09:00:00+09:00 modified: 2026-09-08T09:00:00+09:00 content_type: reporting license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL. --- # Prostate cancer in South Korea: what the evidence says about who is found late, and what happens next The country that became the world's reference case for finding cancer too early has the opposite problem in prostate cancer. This is what the published data shows, where it runs out, and what it never recorded at all. ## Answer South Korea diagnoses prostate cancer late by international standards — 53.9 percent of 27,075 biopsy-confirmed cases were high-risk at diagnosis, and the low-risk share fell from 11.4 percent in 2010 to 7.6 percent in 2020 — while its national datasets record diagnosis, treatment and cost but not continence or sexual function, leaving the trade-off at the centre of the treatment decision undocumented in Korean practice. ## Key takeaways - In 27,075 biopsy-confirmed Korean prostate cancer cases from 51 general hospitals, 53.9 percent were high-risk at diagnosis, against 9.5 percent low or potentially low risk. - High-risk disease accounted for 55.4 percent of cases among rural residents against 47.7 percent among urban residents, which the authors attribute to unequal access to early detection. - The randomised evidence finds no significant difference in prostate cancer death at 15 years between monitoring, surgery and radiotherapy, but monitoring roughly doubles metastasis and progression while surgery does the most lasting damage to continence and sexual function. - Korean institutional protocols for active surveillance differ enough that five-year retention ranged from 53.2 to 79.8 percent across three hospitals, without any difference in the pathology of the men who went on to surgery. - No Korean dataset examined in this coverage records patient-reported continence or sexual function, which is the outcome that determines whether a treatment decision was a good one. ## Full article South Korea is cited around the world as the country that found too much cancer. Its thyroid cancer incidence rose more than tenfold on the back of ultrasound scanning that nobody had asked for, while deaths did not move. This publication has covered that in detail. Prostate cancer in the same country, over the same period, is the other failure. This article is the summary of what our reporting on it has established, and of the two questions it has repeatedly been unable to answer. ### The distribution at diagnosis Korea's insurance claims record that a cancer was diagnosed but not how advanced it was, so the national risk distribution was assembled directly, from the clinicopathological records of every biopsy-confirmed case at 51 general hospitals in six sample years between 2010 and 2020. **53.9%** — of 27,075 Korean prostate cancer cases were high-risk at the moment of diagnosis, while the low-risk share fell from 11.4 percent in 2010 to 7.6 percent in 2020 _Source: Ko YH et al., Prostate International, 2026_ The trend runs in the wrong direction, and it runs unequally: high-risk disease was 55.4 percent of rural cases and 47.7 percent of urban ones. Only about a quarter of newly diagnosed men were eligible for active surveillance even under a deliberately generous definition, and that share fell over the decade too. > **One health system, two opposite failures** > Thyroid cancer in Korea is a flood of tumours that would never have harmed anyone. Prostate cancer is disease that is already advanced when it is first seen. These are not contradictory findings. They are what a system produces when detection is driven by what is easy to scan rather than by a policy about which cancers are worth looking for. ### Whether to test The randomised evidence on PSA screening is now mature. At 23 years the European trial found prostate cancer mortality 13 percent lower in screened men, an absolute risk reduction of 0.22 percent, one death prevented per 456 men invited — and 30 percent more cancer diagnosed. A single invitation, tested in 415,357 British men, reduced prostate cancer deaths from 0.78 to 0.69 percent at 15 years. Those trials were designed against overdiagnosis. Korean testing does not look like the thing they tested: among 166,848 men newly registered with prostate cancer, only 26.7 percent had been repeatedly PSA-tested beforehand, and for 42.2 percent the first test came within three months of registration. A first PSA test in the same quarter as the cancer registration is not screening. ### Whether to treat, and with what At 15 years ProtecT found no significant difference in prostate cancer death between active monitoring, prostatectomy and radiotherapy — 3.1, 2.2 and 2.9 percent, P equals 0.53 — while metastasis and clinical progression were roughly twice as common under monitoring. Of the men assigned to monitoring, 24.4 percent were alive at fifteen years having never been treated at all. The functional trade is close to an exchange. Surgery does the most lasting damage to continence and erections; radiotherapy largely spares continence and instead affects the bowel, with bloody stools becoming more frequent over time rather than resolving. Korean series report far lower rates than that, for reasons that are mostly about the measuring instrument rather than about Korean patients. Two Korean findings sharpen the decision rather than restating it. Membranous urethral length, measured on the staging MRI a man has already had, predicts incontinence after robotic prostatectomy at an odds ratio of 0.83 per millimetre — a number available before the choice is made. And which hospital a Korean man attends changes how long he stays on surveillance, without changing what is found if he leaves it. **The full coverage** - [Korea diagnoses prostate cancer late: half of cases are high-risk when found](https://medicalinsightskorea.com/news/korea-prostate-cancer-high-risk-at-diagnosis) — The national risk distribution, and the rural-urban gap inside it. - [Should I have a PSA test for prostate cancer?](https://medicalinsightskorea.com/faq/should-a-korean-man-have-a-psa-test) — What 23 years of randomised follow-up says, in absolute numbers. - [Surgery or active surveillance for localised prostate cancer?](https://medicalinsightskorea.com/faq/prostate-cancer-surgery-or-active-surveillance) — Fifteen-year survival, six-year function, and the Korean protocol variation. - [Men under surveillance started antidepressants more often than men who were treated](https://medicalinsightskorea.com/news/prostate-surveillance-korea-antidepressants-target-trial) — A Korean target trial emulation whose mortality comparison rests on four deaths. - [Incontinence after prostatectomy is partly predictable before surgery](https://medicalinsightskorea.com/news/prostatectomy-continence-predictable-before-surgery) — Age, urethral length and symptom score, all measurable at the clinic visit. - [What radiotherapy costs, and why Korean numbers look better than British ones](https://medicalinsightskorea.com/news/prostate-radiotherapy-korea-what-it-costs-the-bowel) — Clinician-graded toxicity and patient-reported function are not the same measurement. - [Prevalence rose 170 percent, and most of those men are on hormone therapy](https://medicalinsightskorea.com/news/korea-prostate-cancer-prevalence-adt-what-comes-after) — What accumulates at the far end of late detection, and what it costs the skeleton. ### The two things this evidence does not contain Every piece in this coverage ended at one of two absences, and naming them precisely is more useful than another summary of what is known. 1. No Korean dataset records patient-reported continence or sexual function. Korea's national data records diagnosis, treatment and cost. The best Korean functional evidence is clinician-graded toxicity from single institutions, which systematically records less than patients report. Until a Korean series reports patient-reported function at fixed intervals, the trade-off at the centre of this decision is undocumented in Korean practice. 2. Nothing establishes that testing more Korean men would help them. The Korean data is cross-sectional: it describes who was found, in what state, and what was done. The association between repeated testing and localised treatment is stated by its own authors as an association. The randomised evidence on screening was conducted in European and British men. > **What would change the picture** > A Korean cohort that followed men from diagnosis through treatment while asking them about continence and sexual function at fixed intervals would answer more open questions than any of the studies cited here. It requires no new technology and no randomisation. It requires deciding that the outcome is worth recording. Korea has spent a decade correcting an epidemic of thyroid cancers that did not need finding. The prostate data raises the parallel question, which has had far less attention: whether the same health system is finding the cancers that do, whether the men it misses are the ones furthest from a hospital, and whether anyone is recording what happens to the men it finds. ## Sources - Ko YH, Kim SW, Son NH. Active surveillance could apply to one-quarter of Korean prostate cancer cases: Insights from a 27,075-patient cohort. Prostate International 2026;14(2):127-131. doi:10.1016/j.prnil.2025.12.004. PMID:42382553. https://doi.org/10.1016/j.prnil.2025.12.004 - Ko YH, Kim SW, Son NH. Incidence of High-Risk Prostate Cancer in Korea: Insights From Real-World Data Between 2010 and 2020. Journal of Korean Medical Science 2026;41(14):e10. doi:10.3346/jkms.2026.41.e10. PMID:41978922. https://doi.org/10.3346/jkms.2026.41.e10 - Roobol MJ, de Vos II, Mansson M, Godtman RA, Talala KM, den Hond E, et al. European Study of Prostate Cancer Screening - 23-Year Follow-up. The New England Journal of Medicine 2025;393(17):1669-1680. doi:10.1056/nejmoa2503223. PMID:41160819. https://doi.org/10.1056/nejmoa2503223 - Hamdy FC, Donovan JL, Lane JA, Metcalfe C, Davis M, Turner EL, et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. The New England Journal of Medicine 2023;388(17):1547-1558. doi:10.1056/nejmoa2214122. PMID:36912538. https://doi.org/10.1056/nejmoa2214122 - Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E, et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. The New England Journal of Medicine 2016;375(15):1425-1437. doi:10.1056/nejmoa1606221. PMID:27626365. https://doi.org/10.1056/nejmoa1606221 - Ko YH, Ryu JH, Kim YB, Shin TJ, Kim BH. Does protocol heterogeneity in active surveillance influence clinical outcomes? Insights from a multicenter prostate cancer cohort. Investigative and Clinical Urology 2026;67(2):170-177. doi:10.4111/icu.20250460. PMID:41775447. https://doi.org/10.4111/icu.20250460 - Ko YH, Kim SW, Son NH. Impact of repeated prostate-specific antigen testing on management patterns and personal healthcare spending for prostate cancer: A population-based study National Health Insurance data for 166,848 patients in South Korea from 2010 to 2020. Investigative and Clinical Urology 2026;67(3):263-272. doi:10.4111/icu.20250537. PMID:42065662. https://doi.org/10.4111/icu.20250537 - Huang H, Cai K. Prognostic factors for urinary incontinence after robot-assisted radical prostatectomy: a systematic review and meta-analysis. Journal of Robotic Surgery 2025;19(1):628. doi:10.1007/s11701-025-02803-6. PMID:40987992. https://doi.org/10.1007/s11701-025-02803-6 - Lim J, Jo YY, Lee S, Kim YJ. Clinical outcomes of CyberKnife stereotactic radiotherapy for localized prostate cancer: comparison of 35 Gy in 5 fractions and 36 Gy in 4 fractions. Journal of Radiation Research 2026;67(3):402-411. doi:10.1093/jrr/rrag017. PMID:41978285. https://doi.org/10.1093/jrr/rrag017 ## Citation Andrew Cho (2026). "Prostate cancer in South Korea: what the evidence says about who is found late, and what happens next". 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