On a daily basis, patients ask, “Doctor what are the symptoms of prostate cancer?” When I tell them that most cases of prostate cancer do not include symptoms, the patients are very surprised.
Prostate cancer presently is diagnosed in the early stages. These early cases of prostate cancer are usually diagnosed via a combination of PSA testing, digital rectal examination and a prostate biopsy that will confirm the presence of the disease. Since the advent of routine testing in the 1980s, there has been a stage migration of prostate cancer. Prior to PSA testing, many more cases of high grade disease were found, however the blood testing that has been included in the routine evaluation of men over 50 has led to most cases being diagnosed in the early asymptomatic stages.
Advanced cases of prostate cancer can be associated with assorted symptoms. As the tumor begins to grow, patients can experience lower urinary tracts symptoms that can include a decrease in the force of urinary stream, blood in the urine, and an inability to initiate their urinary stream. These symptoms can mimic those that are seen with enlargement of the prostate, however, advanced disease is usually not associated with a normal digital examination.
There are other symptoms that can occur other than those affecting the lower urinary tract. Generalized malaise and weight loss may be associated with advanced disease. When disease spreads to bone, patients will experience pain that can be severe. Pathologic fractures of the long bones may occur. The bones most commonly effected include the femurs, the pelvic bones and the spine. Symptomatic relief can be accomplished with analgesics or in some cases radiation therapy to the effected bones. Lymph node involvement can also occur and in some cases, depending on the location and size of the lymph nodes, kidney obstruction can occur.
Despite most cases of prostate cancer not being involved with symptoms, patients who experience persistent lower urinary tract symptoms should be evaluated by a Urologist.