Prostate Cancer Symptoms
Even aggressive prostate cancer tends to grow more slowly than other cancers in solid organs, such as stomach or pancreatic cancer. This slow growth creates a large window of opportunity (typically lasting several years) during which the cancer can be detected and cured before it spreads outside the prostate to other areas of the pelvis or to distant sites either in the bloodstream to the bones or through lymphatic channels to lymph nodes. This process of distant spread (‘metastasis’) is already present in 30% of men diagnosed with prostate cancer in the UK and whilst treatable cannot be cured.
Symptoms of prostate cancer
Early prostate cancer has no symptoms. Later stages can produce urinary symptoms, lethargy, nausea, leg swelling and bone pain.
PSA - Prostate specific antigen
This simple blood test is capable of indicating the degree of risk of prostate cancer in most men. It should be combined with a digital rectal examination (DRE) of the prostate, as this doubles the likelihood of detecting prostate cancer (the PSA is normal in 20% of men with prostate cancer). PSA is neither completely sensitive (it has a false-negative rate) nor completely specific (it also has a false-positive rate) for prostate cancer but it remains an extremely useful tool. The normal range for PSA is 0-4 ng/ml. The PSA level in any man fluctuates from day to day, so although absolute PSA levels are important, so too is the trend of PSA results. PSA is increased by age, prostate size, poor bladder emptying, infection, ejaculation, prostate injury (such as biopsy) and cancer. In a proportion of men, none of these can be found. Although it is true that the likelihood of prostate cancer increases with age (75% of men aged over 80 years dying of any cause have evidence of prostate cancer present at post mortem) the evidence suggests that prostate cancer associated with an elevated PSA tends to be 50x greater in size than if the PSA is normal, and therefore poses a threat.
Screening for Prostate Cancer
The opponents of prostate cancer screening argue that there is no proof that screening saves lives but the reality is that until recently there has been no evidence in either direction. A number of screening studies, both in Europe and the USA, are now reporting data that suggest that screening is indeed beneficial in identifying prostate cancer at an early stage, which increases the likelihood of cure, especially if they fall into one of the increased-risk groups (see below). The most compelling evidence is the reduction of prostate cancer-specific death rates in the USA, which coincided with widespread screening for prostate cancer with PSA.
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Reduced mortality after screening |
Men most at risk of prostate cancer
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family history of prostate cancer (2-3x if a first-degree relative is affected). |
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age (55+ years). |
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diet high in animal fat. |
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race (black). |
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obesity. |
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smoking. |
How often should my PSA be checked?
Between the ages of 40-70 men should have their PSA checked regularly. This should be once a year if the PSA is 2-4 ng/ml and once every 2 years if the PSA is 0-2 ng/ml.
What happens if my PSA is elevated?
Two tests are essential:-
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repeat PSA to exclude lab error or an unrepresentative result. |
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urine sample to exclude infection. |
What tests will the urologist do?
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Ask you questions about any urinary symptoms you might have and about your general health. |
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Perform a physical examination, including a rectal examination to assess the size and consistency of the prostate. Prostate cancers generally feel hard. |
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If the rectal examination is normal he/she may check your free PSA level (a different form of PSA in the blood, which is not bound to proteins and provides additional information regarding the likelihood of you having prostate cancer). The PCA3 test is a new prostate cancer gene test, which has 95% accuracy for detecting prostate cancer if present and may replace free PSA tests (http://www.bostwicklaboratories.com/patientservices/PCA3.html). Following a DRE, during which both lobes of the prostate are massaged 3 times, a urine sample is sent to look for over-expression of the PCA3 gene. The results is usually available in about a week. |
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transrectal ultrasound-guided (TRUS) prostate biopsy is performed if the DRE, free PSA or PCA3 test is suspicious for prostate cancer. After the prostate has been anaesthetised with local anaesthetic 12 or more tiny cores of prostate tissue are removed under ultrasound guidance to sample the prostate. Blood in the urine and semen for up to 2 weeks is normal following this procedure but infection is rare if antibiotics are prescribed before and after the biopsy. |
What if the biopsy shows no prostate cancer?
Unfortunately, a negative biopsy does not give a guarantee that no cancer is present due to sampling error (like looking for a needle in a haystack). Your urologist will want to follow you up with a repeat PSA and perhaps PCA3 test after 6-12 months. Further prostate biopsy might be necessary.
It is important to reduce your risk of prostate cancer by making any necessary lifestyle and dietary changes (diet and supplements).
What if the biopsy shows prostate cancer? »
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