Prostate Cancer: Symptoms and Diagnosis
Prostate cancer is most treatable when it is discovered early while it is still localized to the prostate gland. Fortunately, due to greater awareness of the disease by the American public and more doctors advising annual testing, prostate cancer is often detected early enough to be successfully treated. Previously, most doctors recommended that beginning at age 50 all men receive prostate cancer screening with digital rectal exam (DRE) and prostate specific antigen (PSA) blood testing on a yearly or every other year basis. However, the U.S. Preventice Services Task Force is currently revising their recommended screening guidelines and has not published a final recommendation (as of 2018). Their draft recommendations are currently that men ages 55-69 should make an individualized decision about screening for prostate cancer after discussion with a clinician. Then for men ages 70 and older, the taskforce currently recommends against PSA-based screening for prostate cancer.
Prostate cancer does produce a set of symptoms for informed men to look for. It is important to note that these symptoms can also be caused by other prostate conditions that are not prostate cancer. Whether the symptoms are caused by cancer or not, it is important that you see your doctor as soon as possible if you observe any of the following symptoms (and particularly so if you are over 50 years of age):
- Difficulty urinating.
- Painful ejaculation.
- Frequent urination, commonly at night.
- Pain during urination.
- A weak stream of urine.
- The feeling that your bladder has not been fully emptied when you are done urinating.
- Difficulty starting urination.
- Not being able to urinate at all.
- Chills and fever.
- Blood in the urine or semen.
- Pain in the back, hips, or thighs.
If your doctor believes that your symptoms might be caused by prostate cancer, he or she will likely order two initial tests. While these tests cannot inform the doctors for certain if you have prostate cancer, they can give him an indication as to whether or not he should order a biopsy.
- Digital Rectal Exam. The digital rectal exam (DRE for short) involves your doctor inserting a gloved and lubricated finger into your rectum so as to feel for any enlargement or irregularity of the prostate. The DRE is quick and only slightly uncomfortable (frequently more out of embarrassment than actual pain). Unfortunately, the DRE test is only moderately reliable because only one side of the prostate can be examined.
- Prostate-Specific Antigen. The prostate-specific antigen test (PSA for short) is a blood test that measures the amount of PSA, a protein made by the prostate gland, available in your blood. High levels of this protein in your blood may indicate prostate cancer. However, the PSA blood test alone cannot tell for certain whether you have prostate cancer. The PSA test is more reliable for looking for recurrence of prostate cancer in a person who has been previously treated for the condition.
- Prostate Biopsy. The only definitive test available for diagnosing prostate cancer is the prostate biopsy, which involves collection of cells from the prostate gland which are then analyzed under the microscope. To collect the cells, doctors insert a small ultrasound probe into the rectum capable of creating a computer image or map of the prostate and locating the area of suspected cancer. Doctors then insert a small needle through the rectal wall into the problematic area. The needle removes a tiny sample of prostate cells which are sent to the lab for analysis. Sometimes multiple samples must be taken from more than one location.