Prostate cancer symptoms are rare. Prostate cancer symptoms are more likely to occur in stages 3 and 4 of prostate cancer.
During stages 3 and 4 of prostate cancer, when patients may begin to experience prostate cancer symptoms, the cancer is likely to have spread outside of the prostate gland, most commonly to the bones.
As Chief Of Urology, I find myself being asked the same questions again and again when it comes to prostate cancer, and that is a huge motivator for me to continue raising awareness when it comes to men’s health.
Dr. Robert Mordkin is the U.S. Medical Director for LetsGetChecked
Often the questions that my patients ask me are centered around the signs and symptoms of prostate cancer.
Patients ask me: “What physical signs will tell me I have prostate cancer?” and “What are the most common symptoms of prostate cancer?”
It’s not as easy question to navigate because most of the men that get diagnosed with prostate cancer will come into the physician’s office about something else and end up leaving the office with question marks around prostate cancer.
- Prostate Cancer Symptoms: What You Should Know
- What Are The 5 Warning Signs Of Prostate Cancer?
- What Are The 4 Stages Of Prostate Cancer?
- Can Prostate Cancer Kill You?
- Prostate Cancer Treatment: Your Options
Prostate Cancer Symptoms: What You Should Know
Many of the men who get diagnosed will come into the physician’s office with symptoms, but realistically their symptoms are not related to prostate cancer; they will come in with symptoms that are related more to age changes that happen in their prostate.
As men get older, their prostate naturally grows and as a part of that natural growth, they begin to have urinary symptoms. When the prostate grows, it is not solely down to cancer, it is also age-related.
Men may begin to experience symptoms which we refer to as BPH or Benign Prostatic Hyperplasia.
This is described as the enlargement of the prostate and the symptoms can include things like:
- Slowing of the urinary stream
- Having to go to the bathroom or the need to urinate more frequently
- Having to get up more often at night to urinate
- Having a hard time getting the urine flow started once men feel like they need to urinate
- Feeling like they’re not emptying their bladder
- Having to stop and start to completely empty their bladder
Any and all of the above signs are often symptoms of the enlargement of the prostate and those are usually the kind of symptoms that bring a man in to my office and often in the conversation of talking to them about their urinary symptoms, one of the common queries I’ll have is: “Have you ever been tested for prostate cancer?” or “Do you have a family history of prostate cancer?”
Perhaps they have never been tested before, perhaps they have been tested but it was years ago or certainly if they have a family history, they’re going to need to make sure they get tested.
If men have a family history of prostate cancer, there is a much greater chance that they will have prostate cancer and for this reason, they should start testing at a younger age and ensure that they are getting tested frequently.
To circle around on this, it’s important to realize that the symptoms of prostate cancer will really only present themselves if the cancer itself is very very advanced and those kind of symptoms in that setting are things like a blockage of urination so that they can’t urinate, blood in the urine, weight loss and bone pain. Bone pain occurs because one of the things about prostate cancer is that is tends to spread to the bone.
When it comes to prostate cancer testing, it’s really a two pronged approach, no pun intended, but what I mean is that both a blood test and rectal examination is necessary.
The blood test for prostate cancer is commonly known as a PSA (Prostate-Specific Antigen) test. High levels of antigen in the blood may mean a number of things, but it should encourage patients to go for a rectal examination.
Digital rectal exams which feel the prostate through the rectal wall, a man needs to have a rectal exam done in the office to feel what the surface and the contours of the prostate feels like.
Both the PSA blood test and the rectal examination are equally necessary within the screening process for prostate cancer screening.
Even if their PSA is normal, they need a rectal exam, even if their PSA is abnormal, they need a rectal exam. Even if they have a rectal exam and it’s normal, they need a PSA test.
PSA is not a particularly accurate test. An abnormal level does not necessarily mean that someone has prostate cancer, in fact, many men have a PSA number that is considered to be in the abnormal range which is defined as any PSA level above 4.0.
A lot of those men may not have prostate cancer but they do need to be further evaluated to be sure that they don’t have prostate cancer.
The current guidelines for how often someone should be testing with a PSA test and rectal exam and assume that they do not have a family history of the disease and they are of non African-American ethnicity, then they should receive baseline testing around the age of 50 and then continue to get tested every other year up until the age of 75.
In terms of risk factors for prostate cancer, the biggest risk factors include age (as we know, most diagnoses are made over the age of 65), We know that statistically, the longer a man lives, the higher the likelihood he is going to develop prostate cancer.
Another one of the biggest risk factors we need to consider is the family history of the disease, if there’s a first degree relative who has had prostate cancer including a father, uncle or brother, than that risk for that individual is dramatically more increased than somebody who has no family history of the disease.
In the next section, I want to address some frequently asked questions on Google and by my patients to help offer you peace of mind as you address concerns you may have related to your prostate health.
When it comes to talking about the symptoms of prostate cancer, and how closely they are linked to Benign Prostatic Hyperplasia (BPH), it’s important to also mention how the symptoms of BPH come about in differentiating the symptoms of prostate cancer and an enlarged prostate gland.
What are the symptoms caused by the enlargement of the prostate?
The urethra which is the tube that urine traverses through, it’s the tube that the bladder basically needs to push the bladder through.
The prostate gland is a small gland that is located just below the bladder, the urethra runs through the prostate like a straw going through the middle of an orange.
As men get older, the prostate gland grows as a natural part of ageing. The growth is happening in three dimensions so not only is it growing out, it’s also growing in, so that inner growth begins to compress that urethra. It’s compressing that urethra, or the straw if you will, in this analogy. It’s like stepping on a garden hose. It’s obstructing the flow out of the urethra, the bladder then has to work harder.
The bladder is essentially a hollow muscle that has to push the urine out and the bladder then has to generate higher pressures to achieve that to flow and when that happens the stream tends to slow down, the bladder becomes a little bit more excitable or a little bit more irritable which means the urinary frequency increases. It may be harder for the bladder to empty to completion which means you have to urinate more often to get it empty. Men with prostate cancer will have to strain to void. It’s harder to get the urine started, it’s all created by that compression of the urethra.
As the prostate gland gets a little bit bigger, it also has a higher tendency to bleed, that is where the blood in the urine is coming from. If a man or woman sees blood in the urine or if a female sees blood in the urine as well, they need to be seen immediately. They should never discount that finding.
The reason is not because of prostate cancer or BPH, it’s because when somebody comes in with blood in the urine, particularly if the only symptom they have is blood in the urine (there is no pain with urination) - we would be very worried about that individual having bladder cancer.
So yes, while blood in the urine could come from BPH and yes it actually could come from benign prostate cancer and it could even come from a small stone in the kidney, all of those are possible but the reality is that we need to see that person right away and we need to evaluate them more thoroughly.
One of the most common queries regarding prostate cancer is the warning signs that might indicate that you have prostate cancer.
What Are The 5 Warning Signs Of Prostate Cancer?
There really aren’t five signs, you can’t really narrow it down to five and in fact the thing that is so scary about prostate cancer is that at least until it's very advanced, until it’s very decimated, which is when it is often too late to cure it.
For prostate cancer, the most typical age of diagnosis is when a man is in his mid-sixties. It’s very unusual to ever see it before the age of 40.
We know that for each decade that a man lives, the chance of getting prostate cancer goes up. The statistics say that at least 1 in 9 men in the United States will be diagnosed with prostate cancer which works out mathematically to about 175,000 new diagnoses per year in the U.S. right now. A little over 30,000 men will die from prostate cancer this year in the United States.
African American men are more likely to get prostate cancer at a higher rate and they also tend to get a more aggressive disease as well which is why they need to be screened more frequently, there is some thought that a Western diet, which is a higher fat diet may put people at higher risk for prostate cancer.
It’s very hard to point to a lifestyle recommendation that say “Okay if you do A, B and C diet wise or vitamin wise or erb wise or somehow increase or decrease your risk by a certain percentage, my one piece of advice would be to increase a plant based diet a little bit. It may help somewhat, that is married to staying away from high in fat westernized diets anyway.
While smoking isn’t directly related to prostate cancer, it will lower your cancer risk in general if you don’t smoke. Smoking isn’t good for anything so, that is just another lifestyle recommendation there.
There’s a lot of interest about whether there are vitamins and minerals that can lower your risk of developing prostate cancer. There’s controversy out there around Zinc, Vitamin E and Selenium is another one that is commonly talked about.
It is important to note that none of these minerals have been definitively proven to reduce the risk of getting prostate cancer.
What Are The 4 Stages Of Prostate Cancer?
The severity of your cancer really depends on where your cancer is at. It ranges from stage 1 which is really where your prostate cancer was detected, not because of any ouvert sign or symptom that anybody felt on exam or anything like that but it would be detected because maybe there would be another procedure and then we might find microscopically that there is a small amount of prostate cancer.
It’s at a very early detection and it’s often incidentally found in stage 1.
Stage 2 is perhaps just a little bit beyond that meaning that there is a little bit more cancer there but it is still fairly early and because of that, it is confined to the prostate, it hasn’t spread outside the gland itself.
We want to catch it if we can in the stage one or stage two level. When we get to stage 3 and certainly to stage 4, it becomes more worrying. Stage three means it is going outside of the prostate but it hasn’t gone particularly far, stage four means it has now gone to other parts of the body.
Stage three and stage four are bad because that means they have got a disease that is now more advanced. That person will probably never be cured from their prostate cancer.
The goals of treatment for those people is to try and slow the cancer down for as long as you can but we’re not going to ever fully eradicate the cancer from the body fully.
The challenging goal for us is to catch prostate cancer in stage 1 or stage 2.
Can Prostate Cancer Kill You?
It is estimated that approximately 31,000 people will die this year in the U.S. from prostate cancer.
It is believed that if prostate cancer is caught early, while it is still in early stage and confined to the prostate, treating the disease can actually provide cure and improve survival. Interestingly, many men who develop prostate cancer actually have non-aggressive prostate cancer and actually don't require any treatment at all. Rather, they simply need to be monitored closely to be sure that there disease does not change and become more aggressive.
Prostate Cancer Treatment | Your Options
For stage 1 or 2, the options include expectant management (which means just monitoring but not treating) vs. radiation to the prostate vs. surgical removal of the prostate. This last option, also known as a radical prostatectomy, is a more popular choice for younger men with more aggressive disease. The surgery can be performed using a laparoscopic robotic technology.
For more advanced disease, stage 3 or 4, the treatments are designed to control and slow down the cancer since it has already spread beyond the prostate. This is usually achieved by prescribing a medication that slowly attempts to kill cancer cells. This can be one of the leading causes of low testosterone in men.
Written By Dr. Robert Mordkin | Edited By Hannah Kingston