Men's Health: What are the 5 Warning Signs of Prostate Cancer?

Prostate cancer can have a bit of a misleading reputation when it comes to the serious nature of the disease. Despite being the second most common cancer in men, prostate cancer is the most survivable cancer you can be diagnosed with – it carries a 99 percent five-year survival rate largely due to how slowly cancer cells grow.

While these numbers are favorable, prostate cancer can still be deadly when men ignore potential warning signs that indicate a more advanced form of cancer. Understanding these signs and symptoms, along with what to do with this information, can potentially save your life.

Warning signs of prostate cancer

Because prostate cancer develops so slowly, symptoms aren’t typically present until the cancer reaches an advanced stage. That said, many of these signs and symptoms can be tied to aging or other health problems – the prostate wraps around the urethra and helps produce semen, so any issues urinating or ejaculating may be confused with prostate cancer. In other words, having one or more of these symptoms doesn’t mean you automatically have prostate cancer. Instead, it should prompt a visit to a urologist for further evaluation.

Here are five common possible warning signs of prostate cancer:

Difficulty urinating. It’s common for older men to have issues urinating, mainly due to benign prostatic hyperplasia, an age-associated prostate gland enlargement. However, more advanced stages of cancer can cause the prostate to press against the urethra, making it difficult to start or stop the flow of urine.

Frequent urination. Tumors can become large enough to where they press on the bladder and urethra, giving you the sensation to urinate frequently. This feeling may be more evident at night.

Pain while urinating. Cancerous cells in the prostate can impact surrounding nerves and muscles, causing painful urination known as dysuria. 

Blood in urine. Hematuria, the medical name for blood in the urine, can stem from bladder irritation caused by prostate cancer.

Issues with sexual health. Painful ejaculation, erectile dysfunction and blood in semen can be several things, including a sexually transmitted disease or a psychological issue. But they could stem from prostate cancer.

How is prostate cancer diagnosed?

If you experience any of these symptoms and think you may have an issue with your prostate, one of the following three screening tests and exams can determine if you have prostate cancer.

Prostate-specific antigen test

The prostate makes a protein called prostate-specific antigen (PSA) that is found in semen and blood. The blood test, measured in nanograms per milliliter (ng/mL), helps identify the possibility of prostate cancer. 

In general, 4 ng/mL is the threshold urologists use when deciding if more testing is needed. A PSA between 4 and 10 comes with a 25 percent chance of prostate cancer, while a PSA of more than 10 comes with a 50 percent chance of prostate cancer.

One important note: A high PSA doesn’t mean you have prostate cancer, nor does a low PSA mean you’re cancer free. Many other environmental or medical factors can also contribute to a low or high PSA. For example, old age and an enlarged prostate can lead to a high PSA. However, this doesn’t mean you have cancer. Likewise, medications that treat heart conditions such as statins and diuretics can lower PSA levels.

Digital rectal exam

A digital rectal exam is a physical exam in which a doctor inserts a finger into your rectum to feel for any lumps or tumors. A DRE isn’t the most effective method, as your doctor can’t also feel cancerous areas, but prostate cancer sometimes starts at the back of the gland that is most accessible during the exam.

The American Cancer Society recommends an annual rectal exam starting at the age of 40 for men who have a family history of prostate cancer. Starting at age 45, men at a high risk for any type of cancer should receive an annual rectal exam. At age 50, they recommend all men receive an annual rectal exam.

Biopsy

For anyone suspected of cancer growth, a urologist will perform a biopsy to check for cancerous cells in the prostate. A biopsy involves the use of a needle to remove prostate tissue, which is then examined under a microscope.

The procedure uses imaging from a transrectal ultrasound to guide the needle into the tissue. The needle can either be inserted through the rectum (transrectal biopsy), the skin between the scrotum and rectum (perineal biopsy) or the urethra via a flexible tube called a cystoscope (transurethral biopsy).

Treating prostate cancer

Depending on your diagnosis, there are several ways to treat and monitor prostate cancer, although only two options can leave you cancer free – surgery and radiation. Beyond that, less invasive approaches include active surveillance and hormonal therapy. 

Hormone therapy for prostate cancer

Hormonal therapy is typically used to treat prostate cancer in recurrent cases or when the tumors reach a more advanced stage and can’t be cured by surgery or radiation.

Doctors use this type of treatment to suppress androgens in your body. Androgens are male hormones that help prostate cancer cells grow. Testosterone and dihydrotestosterone (DHT) are the most common androgens, and they are produced by either the testicles or the adrenal glands.

The main hormonal therapy options include orchiectomy (a surgery in which the testicles are removed) and various medications to suppress androgens. For example, luteinizing hormone-releasing hormone (LHRH) agonists lower testosterone produced by the testicles and anti-androgens keep androgens from causing tumor growth. Other medications, such as abiraterone and ketoconazole, block the production of androgens made by the adrenal glands.

The main drawback with androgen suppression is the short-term and temporary nature of its effects, meaning it isn’t an option to cure prostate cancer.

Active surveillance for prostate cancer

Since prostate cancer is such a slow-growing cancer, many doctors recommend observation or active surveillance.

Active surveillance involves frequent visits with your doctor to monitor your prostate cancer tumor growth. For example, your doctor may suggest ordering prostate-specific antigen tests (called PSA tests) every three months, along with an annual biopsy. 

A PSA result of less than 10 means it’s unlikely the cancer has spread. A PSA result of more than 10 would require a longer discussion of how to move forward with treatment.

Observation, also called watchful waiting, involves fewer tests.

Active surveillance and observation are most suited for men who either don’t have symptoms or have a tumor that is small and will grow slowly.

Surgery for prostate cancer

For cases of prostate cancer that require surgery, a surgical oncologist will perform a radical prostatectomy, a procedure that removes the prostate gland, the surrounding tissue and seminal vesicles that help make semen. 

The surgery is either done through an open or laparoscopic approach. Over the years, laparoscopic prostatectomy has become a more common surgical treatment due to smaller incisions and shorter recovery time. However, a skilled surgeon is needed since there is less margin for error. 

By compassion, an open prostatectomy involves a longer incision from the pubic bone to the belly button that allows the surgeon to remove the prostate.

While the surgery itself can be successful, side effects include incontinence and erectile dysfunction. 

Radiation treatment for prostate cancer

Due to the impact prostate cancer surgery can have on your quality of life in terms of urinary incontinence and sexual health, many people opt for radiation as the first line of defense.

Radiation can either treat prostate cancer in its infancy before it grows and spreads or in its advanced stages when it spreads to nearby tissues.

There are several types of radiation to receive based on your initial diagnosis. Brachytherapy, also called internal radiation, can treat localized prostate cancer. Treatment involves the implantation of radioactive pellets directly into prostate tissue to shrink cancer cells. External beam radiation is used to treat moderate to advanced cases of prostate cancer. In other cases, radiopharmaceuticals – drugs containing radioactive elements are injected into the bloodstream – can be used to target cancer cells.

If you’re at risk of developing prostate cancer or have symptoms that may be indicative of a prostate issue, contact a urologist for further examination.