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Last updated October 31, 2019. 6 minute read

Prostate cancer: the signs and symptoms

Early-stage prostate cancer doesn’t usually cause symptoms. Men with lower urinary tract symptoms (LUTS) are no more likely to have prostate cancer than men without them.

Dr Tzvi Doron Do Written by Dr. Tzvi Doron, DO
Reviewed by Dr. Melynda Barnes, MD

Prostate cancer. It’s one of the most feared cancer diagnoses by men, and with good reason. After skin cancer, it’s the most common cancer (ACS, 2019) in men and the second most common cause of cancer death. And while most men with prostate cancer will not die from the disease, death is not the only scary thing about it. 

Firstly, there’s a visceral fear associated with the walnut-sized gland’s location within the genitourinary system. Then, related to that,  there’s the fact that treatment for prostate cancer can cause side effects, including sexual dysfunction and urinary incontinence. 

It should be noted though that these symptoms are less common and easier to deal with than they once were. More heartening news: with the right information and a good support system, most men can live productive lives after a prostate cancer diagnosis.

VitalS

  • Early-stage prostate cancer doesn’t usually cause symptoms.
  • Men with lower urinary tract symptoms (LUTS) are no more likely to have prostate cancer than men without them.
  • Most prostate cancer diagnoses are a result of screening.
  • Screening is performed by measuring prostate-specific antigen (PSA) levels with or without a digital rectal exam (DRE).
  • Some medical societies maintain that the risks of prostate cancer screening in the general population may outweigh the benefits.

Symptoms of prostate cancer

Unsurprisingly, men want to know what to be on the lookout for in terms of prostate cancer symptoms to improve their prognosis in the event that they have the disease. Generally speaking, though, curable, early-stage tumors (stages 1 and 2) don’t cause symptoms.  Indeed, most screen-detected cancers are found in men without any symptoms, which we’ll touch on in just a moment.  

Until quite recently, it was thought that prostate cancer (Hamilton, 2004) caused symptoms due to tumors pressing on local structures, and causing lower urinary tract symptoms (LUTS). LUTS symptoms include:

  • Urinary hesitancy
  • Urinary leakage
  • Urinary urgency
  • Weak urinary stream
  • Pain or discomfort when urinating (dysuria)
  • Urinary frequency, including at night (nocturia)

It’s important to understand that (LUTS) do not occur only in prostate cancer. Most of the time, LUTS result from benign conditions, most commonly benign prostatic hyperplasia (BPH), the most typical cause of enlarged prostate. 

More recent studies (Bhindi, 2017) examining the relationship between LUTS and prostate cancer suggest that the presence of LUTS does not increase the risk of having prostate cancer. Another way to interpret these findings: men with LUTS are no more likely to have prostate cancer than men without LUTS. Regardless, experiencing LUTS is absolutely enough of a reason to make an appointment with your doctor who may or may not decide that a prostate cancer screening test is appropriate for you. 

Another way prostate cancers can cause symptoms is by metastasizing (spreading) to distant organs. By definition, metastatic prostate cancer is stage IV. The most common place that prostate cancer spreads is the bones, including the spine and ribs. In these cases, pain is the most common symptom, often present in any position and sometimes worse at night. 

Less common symptoms of prostate cancer include blood in the urine or semen, weight loss, and weakness or numbness of the legs due to tumors pressing on the spinal cord.

Prostate cancer screening

It’s important to understand that prostate cancer generally does not cause symptoms until it is at an advanced stage. What that means is that most prostate cancers, at least in developed countries, are diagnosed through screening. Screening is done with PSA testing with or without a digital rectal exam (DRE). Recommendations for prostate cancer vary, depending on the medical society. 

The American Urological Association (AUA) recommends (Detection, 2018) that:

  • Men younger than 40: prostate cancer screening not recommended
  • Men aged 40-54: screening should be  individualized, with risk factors for prostate cancer taken into consideration. 
  • Men aged 55-69: men should engage in shared decision-making with their doctors when deciding whether to screen for prostate cancer. 
  • Men older than 70: prostate cancer screening not recommended

The AUA also recommends that screening be performed by measuring prostate specific antigen (PSA) levels with or without a DRE.

The United States Preventive Services Task Force (USPSTF) has recommendations (USPSTF, 2018) that are very similar to the AUA while The American Academy of Family Practice (AAFP) recommends (AAFP, 2018) against routine screening for prostate cancer because they believe the risks outweigh the benefits. 

Those risks include the possibility of a biopsy resulting in pain, bleeding or infection and the psychological effects of knowing that prostate cancer is present, even if it’s a slow-growing tumor that doesn’t result in illness. The AAFP is unclear about whether doctors should start a conversation with men about screening or should only screen if someone asks for it specifically. 

Living with prostate cancer

Receiving a diagnosis of prostate cancer can be devastating, but there is hope in the form of an array of treatment options which fall into the following categories. 

  • Radiation therapy: There are different types of radiation therapy, including intensity-modulated radiation therapy (IMRT), stereotactic radiosurgery and high and low dose rate brachytherapy. Each approach comes with various benefits and drawbacks.
  • Radical prostatectomy: This consists of complete removal of the prostate gland. Radical prostatectomy and radiation therapy are the mainstays of treatment for early stage (stages 1 and 2) disease.
  • Active surveillance/active monitoring: This includes monitoring the cancer for signs of progression, which would prompt treatment.
  • Hormone therapy: This is usually reserved for advanced prostate cancers and involves lowering testosterone production or blocking its action.
  • Chemotherapy: This is is employed when advanced prostate cancers are not responding to hormone therapy.
  • Experimental treatments: These include cryotherapy and the prostate cancer vaccine.

If you’ve been diagnosed with prostate cancer, work with your doctor to figure out which treatment option is best for you. Make sure to include your loved ones in your journey as support from friends, family, romantic partners — even relative strangers who have undergone treatment themselves —  can make it much easier to go through this challenging process and can have a marked effect on outcomes. 

Research (Zhou, 2010) from 2010 found that higher levels of social support at the beginning of treatment (either radical prostatectomy or radiation) predicted better emotional well-being two years later. Another study (Imm, 2017) from 2017 study looked at the effect of social support on African American men who had undergone a radical prostatectomy. Researchers concluded that strengthening social support may help improve quality of life. 

Yet more recent research (Lienert, 2017) has shown that social interaction can boost the effectiveness of chemotherapy. Scientists found that chemotherapy patients who interacted with other patients who had undergone chemotherapy and survived for five years or more, saw an increase in their own survival rate. The study’s authors speculate that this outcome may be due to social interaction decreasing stress and the body’s hormonal response to it. 

Put simply, accepting or inviting the help and attention of others may have positive and tangible impact on your experience of prostate cancer.