Prostate cancer is the most common cancer among men and the second leading cause of cancer-related death in men in the United States.The average age at the time of diagnosis is about 66 years old, with about six cases in 10 diagnosed in men aged 65 or older and very few diagnosed before age 40. Have a look at my blog – How to be a Healthy Dad
Prostate cancer can have no symptoms at all and there is no definitive screening protocol for cancer, due to false positives and false negatives among current screening tests. When detected, 90% of cancers are found locally within the prostate and have not spread to other parts of the body, which means that nearly 100% of men at this stage are disease-free after five years.
If you are worried about prostate cancer, learn to recognize the symptoms and increase your awareness around testing and the stages of prostate cancer so that you get treatment as quickly as possible.
Recognizing the Early Symptoms of Prostate Cancer
Document any symptoms you notice, so that you can tell your doctor about them. These symptoms are not definitive proof that you have prostate cancer, but they should be a signal to you that you need to get screened by a doctor.
Pay attention to your urination cycles.
Changes in urination cycles — both drastic and gradual — may indicate prostate cancer. Due to its location, the mass from cancer can push up against your urethra or bladder, preventing normal flow of urine. This is called a weak or slow flow.
Note if it takes you longer to complete urinating or if the urine is slow/dribbling from your penis. Other changes to watch for include:
- Wanting to go to the bathroom but no urine comes out. The mass from the prostate may have blocked off the urethra or bladder opening to the urethra.
- If you feel you have to go but nothing comes out the penis or very small dribbling of urine, you may have a more severe blockage of the urethra/bladder.
- Having the urge to urinate more at night or waking up with the feeling. Since the mass obstructs urine outlet, your bladder may not empty entirely during the day. So when you are sleeping the bladder it fills up faster due to the urine previously there.
- You may also get the sense you want to urinate but you cannot due to the mass blocking the urethra/bladder.
You can check other changes in your urination cycle against a questionnaire that is used by urologist and primary care doctors, located here: http://www.urospec.com/uro/Forms/ipss.pdf
Look for blood in your urine or a pink/red urine tint.
Due to the enlarging mass from prostate cancer new blood vessels may form and many others may get injured. Also, enlargement of the prostate may lead to prostatitis (inflammation of the prostate) and increase urinary tract infections which can cause blood in the urine.
Blood in urine is known as hematuria.
Pay attention to painful ejaculations (orgasm).
It is well-documented that there may be an association of prostate cancer with prostatitis (inflammation of the prostate from infection).When this occurs the inflammation of the prostate can irritate the gland upon ejaculation causing painful orgasms.
Identifying the Symptoms of Advanced Prostate Cancer or Metastasis
Look for symptoms of advanced prostate cancer or metastasis (spread of cancer to other locations). Urinary tract infections, BPH, and prostatitis will not present with metastatic signs of cancer. There are a variety of symptoms that can go along with advanced prostate cancer. You should keep an eye out for these if you are at risk of prostate cancer or have had it in the past.
Pay attention to unexplained nausea, vomiting, constipation, and confusion.
Prostate cancer can attach to bone causing a deep bone pain, weakness, and eventually broken bones. The calcium from the bone can empty in the blood leading to increased levels causing nausea, vomiting, constipation and confusion.
Be aware that swollen extremities (arms or legs) or weakness in the legs, arms, or hips bones can be a sign of prostate cancer. Prostate cancer can spread to the lymph nodes. These nodes are located throughout the body including around the pelvic area.
They help filter and empty out fluid into the blood. When these become blocked by cancer tissue they will enlarge and cause swelling of the area. Look for swelling in your extremities such as the legs or arms. If you think one side is affected compare it to the other side.
Pay attention to unexplained shortness of breath, chest pain, and/or coughing up blood.
Prostate cancer can spread to the lungs. Look for a cough that cannot be treated with over-the-counter remedies or antibiotics, chest pain that may be throughout or isolated to an area, shortness of breath and coughing up blood.
The cancer interrupts normal lung functioning, leading to damage and inflammation of the tissue and arteries. Inflammation will lead to fluid accumulation within the lining of the lungs (pleural effusion) and can cause shortness of breath and aching chest pain
Watch for a combination of symptoms that may indicate prostate cancer.
Difficulty walking, headaches, sensation loss on certain parts of my body, memory loss, and trouble holding urine — when experienced together — can be signs of advanced cancer.
The most common cancer spread to the brain from the prostate is called Leptomeningeal carcinomatosis. It can present with headaches, sensation loss on the body, difficulty walking, unable to hold urine (incontinence), and memory difficulties.
Pay attention to back pain and tenderness to touch.
Prostate cancer can spread to the spinal cord. This can lead to compression of the spinal column causing back pain, tenderness and muscle weakness with or without sensation loss. Neurological problems may arise such as urinary retention or, less frequently, bladder or bowel incontinence.
Watch for bleeding from the rectum while going to the bathroom.
This can be a sign that cancer has spread to the rectum. Case studies have documented prostate cancer can spread to the rectum due to its close proximity. Look for bleeding and/or abdominal pain from the rectum when passing stool.
Understand that symptoms associated with prostate cancer could be symptoms of a different illness.
For example, a urinary tract infection may present with burning on urination and fever but will not have any of the other symptoms of prostate cancer.
In either case, whether the burning and fever are symptoms of prostate cancer or a urinary tract infection, you should see your doctor. Best practice is to seek expert medical advice and perform the routine exams and tests for a proper diagnosis.
- Prostatitis may present with the same symptoms as prostate cancer but tends to be more painful in the lower abdomen, lower back, and pelvic region. Prostatitis may be due to an infection and can present with a fever where cancer does not.
- Benign prostatic hyperplasia (BPH) can mimic prostate cancer symptoms to the point where only diagnostic test and examination will help rule cancer out. Though, BPH most commonly present with lower urinary tract symptoms such as urgency to urinate, weak urine stream, waking up at night to go to the bathroom (nocturia) and straining to void urine.Also, almost 50% of men aged 50 to 80 may experience erection or ejaculation difficulties.
- Nocturia (nighttime urination) is common as you age. The bladder loses elasticity and its ability to hold more urine the older you get. In addition, our bodies make less hormones over time, which slows down our kidney function at night causing more urine production than normal.
- This combination leads to frequent waking up and nighttime urination as well as more urination during the day. BPH and prostate cancer can cause nocturia but will normally present with weak stream of urine, lack of urination, burning sensation in penis from urinating, painful ejaculation and trouble getting an erection.
- Frequent daytime and nighttime urination can also be a symptom of diabetes (high blood sugar), which can also have serious complications. It is advised to seek medical advice from your doctor if you experience excessive nighttime and daytime urination.
- Keep a diary, this is a two-day record of how much you drink, how often you have to go the bathroom and the urine output, any medications you are taking, any urinary tract infections, and any related symptoms. Your doctor will review the diary in order to determine the possible cause(s) of and treatment for the nocturia.
Be aware that there may be no symptoms present with prostate cancer.
Many men with prostate cancer often have no symptoms at all. If you are at risk of prostate cancer, then it is a good idea to get checked on a regular basis, whether you have symptoms or not.
Diagnosing Prostate Cancer
Visit your doctor. It is advised to seek medical advice if you have any of the symptoms of prostate cancer. There are many other possible diagnoses, such as prostatitis, urinary tract infection, and benign prostatic hyperplasia, that can mimic cancer but it is best to rule out prostate cancer as soon as possible.
Your doctor will take a detailed history and physical examination to order the appropriate workup, and will ask about your symptoms, family history, diet, sexual history, and the use of any substances such as drugs or tobacco.
Know how your doctor will diagnose prostate cancer.
While you can tell your doctor about your symptoms, a clear diagnosis can only be done with specific medical tests. If cancer is probable or needs to be investigated, your doctor can perform a variety of screening exams or tests:
- Digital rectal examination (DRE). Your doctor will feel for your prostate with a gloved and lubricated index finger through your rectum. The doctor will then palpate the part of your rectum facing your belly button; the prostate lies above/in front.
- The doctor is feeling for any irregular shapes (lumps and bumps), contour (smooth or not smooth), size and tenderness. Abnormal findings include firm, bumpy, nonsmooth, and enlarged prostate.
- Normal DRE does not rule out prostate cancer unfortunately.Prostate specific antigen (PSA) blood test. Your doctor will insert a needle in your arm and collect blood and send it out for detection of PSA.
- This is a specific protein found in your prostate. Most doctors conclude a level of 4ng/ml or lower is considered normal. Men with a PSA level between four and 10 have about a one in four chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50% (10).
- PSA levels cause false positive or false negative results. Elevated levels may not indicate prostate cancer or issues — it serves as a guide. Normal levels do not indicate you don’t have cancer. Ejaculation (recent sexual activity), prostate infection, digital rectal examination and bike riding (this puts pressure on the prostate) can cause elevations of PSA.
- Those without prostate symptoms and elevated PSA may require repeat testing after two days. Repeat elevated PSA levels may warrant a DRE and/or biopsy of the prostate (needle inserted to take a piece of the prostate tissue for analysis) if symptoms are present.
- Cancer can occur even with normal results from the PSA test.
TransRectal Ultrasound (TRUS). A small lubricated probe will be inserted into the rectum and emit sound waves that can produce a picture on the screen.
- What the doctor is looking for is enlarged size, abnormal shape and contour. This method cannot always tell the difference between normal and prostate cancer.
- Biopsy. This involves using a TRUS to guide a needle into the prostate gland and take a sample of the tissue for analysis. Your doctor will sample more than one area of the prostate for analysis.
- This is a definitive test for both BPH and prostate cancer. Your doctor may elect to undergo this if there is high level of suspicion but previous studies have come back negative/normal. A pathologist will use a Gleason grading system to analyze the tissue biopsy of the prostate.
- A grade from one to five can be assigned with five being cancer cells present and one being normal tissue present. If cancer is present, most biopsies are grade three or higher, and grades one and two are not often used.
Dr. Oz Talks Prostate Cancer Screening And Treatment: What You Need To Know | TODAY