Prostate cancer is a serious disease that affects thousands of men during middle and late age, with most prostate cancers occurring in men over age 65. As men get older their prostate gland often enlarges. This is usually not due to cancer. It is a condition called benign prostatic hyperplasia (BPH). BPH does not usually develop into cancer but an enlarged prostate may sometimes contain areas of cancer cells.
Very early prostate cancer generally does not cause any symptoms at all. Many prostate cancers start in the outer part of the prostate gland, away from the urethra. If a tumor is not large enough to put much pressure on the tube that carries urine out of the body (the urethra), you may not notice any effects from it.
The earliest prostate cancer symptoms are often urinary. Warning signs can include:
•frequent urination
•urination that burns
•difficulty with starting urine flow
•weak flow, or ‘dribbling’
•blood in the urine
Many of these symptoms can be indicative of noncancerous diseases of the prostate. These include benign prostatic hyperplasia (BPH), also known as an enlarged prostate, as well as prostatitis (inflamed prostate gland, usually due to infection).
The difference is that BPH and prostatitis usually don’t cause bloody urine. If you see blood in your urine, call your doctor for an evaluation right away.
Symptoms like bloody discharge or extreme pain may warrant an immediate cancer screening.
Getting regular cancer screenings is also important, particularly if there’s a history of the disease in your family. According to the NCI, men with brothers or fathers with prostate cancer are up to three times more likely to develop the disease. Your risk may also be greater if breast cancer runs in your family. Sharing this information with your doctor can help you get timely testing done should any suspicious symptoms arise.
Digital rectal exam (DRE): During a DRE, your doctor will put a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suggest additional testing to check for prostate cancer.
Prostate-specific antigen (PSA) is a substance made by cells in the prostate gland (both normal cells and cancer cells). PSA is mostly found in semen, but a small amount is also found in the blood.
Most men without prostate cancer have PSA levels under 4 nanograms per milliliter (ng/mL) of blood. The chance of having prostate cancer goes up as the PSA level goes up.
When prostate cancer develops, the PSA level usually goes above 4. Still, a level below 4 does not guarantee that a man doesn’t have cancer. About 15% of men with a PSA below 4 will have prostate cancer on a biopsy.
Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, your doctor may advise either waiting a while and repeating the test, or getting a prostate biopsy to find out if you have cancer. When considering whether to do a prostate biopsy to look for cancer, not all doctors use the same PSA cutoff point. Some may advise it if the PSA is 4 or higher, while others might recommend it starting at a lower level, such as 2.5 or 3. Other factors, such as your age, race, and family history, may affect this decision.
If you choose to be screened for prostate cancer, most doctors will recommend that you have both screening tests. It’s important to remember that these tests only help your doctor determine whether your prostate is healthy. An abnormal screening test result does not mean that you have cancer.
Seek medical attention if you have the following:
You cannot urinate.
•You have symptoms of a urinary infection. For example: ◦You have blood or pus in your urine.
◦You have pain in your back just below your rib cage.
◦You have a fever, chills, or body aches.
◦It hurts to urinate.
◦You have groin or belly pain.
•You have pain in your back or hips.
•Your pain isn't controlled.
•You are vomiting or nauseated.
Watch closely for changes in your health, and be sure to contact your doctor if:
•You have pain when you ejaculate.
•You have trouble starting or controlling your urine.