I was recently evaluating a patient for an elevated prostate specific antigen (PSA) of 5.0 ng/ml with no other medical problems. He was 55 years old and only complained of occasional urinary frequency. His PSA was obtained during his yearly physical and his prostate exam was unremarkable. As to be expected, he was concerned and asked me if there were any symptoms associated with prostate cancer.
Symptoms of prostate cancer range from nothing to severe back pain and blood in the urine often depending on the severity of the cancer. When men have a small focus of prostate cancer, for example the size of a pea, there are usually no symptoms related to the cancer. These men tend to have a PSA less than 10 ng/ml. On rare occasions, some of these men may experience mild urinary frequency and urgency and the urologist might see microscopic blood in the urine.
As the cancer grows to a larger size, men can experience signs of urinary blockage from the cancer obstructing the flow of urine from the bladder. These are the same symptoms of prostate enlargement also known as benign prostatic hyperplasia (BPH). These include urinary frequency, urgency, slow urinary stream and waking at night to urinate. It is important to know that, although symptoms may be similar, prostate cancer and BPH are different diseases. A man can have BPH without prostate cancer but prostate cancer can develop in a man with BPH.
Untreated prostate cancer will spread (metastasize) to the bladder, lymph node and bones. This will cause serious symptoms such as blood and clots in the urine, weight loss, urinary retention and bone pain. When the cancer invades the bladder it can obstruct the ureters, the tubes that connect the kidneys to the bladder. If this happens, a man can develop kidney failure. This can take months to develop. The signs and symptoms of kidney failure include fatigue, loss of appetite, nausea, leg swelling and itching.
Since the discovery of PSA, men are being screened for early signs of prostate cancer. As long as men are regularly having heir PSA checked, it is becoming rare to see a patient with a PSA greater than 10 ng/ml. In general, men have no symptoms at the time of their diagnosis.
The patient mentioned above underwent a prostate biopsy in my office and fortunately the pathology revealed normal prostate tissue. He is going to get another PSA in 6 months.