What you need to know about prostate cancer - symptoms and diagnosis
A quarter of the men diagnosed with prostate cancer will die from it. Despite more screening it's the 2nd most common men's cancer.
This hub gives an overview of the symptoms and diagnosis. Treatments are varied and what is suitable for one man won't be suitable for another man's disease so we’ll discuss them in other hubs.
What is the prostate?
The prostate is a gland that produces fluid in which the sperm swim as part of the ejaculate. In the body it sits just below the bladder, between the bladder and the rectum (see the picture).
When and how does prostate cancer happen?
It's unusual before the age of 50 and occurs most commonly between the ages of 65 and 85 years.
The tumour is usually slow growing so symptoms may not become apparent for some years. This means that it may have spread by the time it's diagnosed which is what makes the disease so deadly.
The symptoms include
- Problems passing urine for example pain, difficulty in starting or finishing the stream, dribbling
- Not being able to pass urine (acute urinary retention)
- Blood in the urine
- Lower back pain
- Pain when ejaculating
- Blood in the sperm
- Pain in the testicles (balls).
Who is at more risk of prostate cancer?
Prostate cancer is more common in men over 65 years, so older age is a risk factor
It's less common in Oriental men but Japanese migrants to the West are more likely to take on the same incidence of the disease as men in their adopted country.
It's most common in Afro-Caribbean men and in those with a first degree relative who has/has had breast or prostate cancer. A first degree relative is a father, brother, son, mother, sister or daughter.
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Men with any of the symptoms above should talk to their doctor if they are concerned and especially if the symptoms persist.
The PSA blood test is often (but not always) high in men with prostate cancer. PSA stands for Prostate Specific Antigen and it can also be high in men who have prostatitis (an infection in the prostate) or benign prostatic hyperplasia (BPH) where the prostate is enlarged but not cancerous.
Early prostate cancers often have a low PSA and the tumour may not be detectable when the doctor does an internal exam - a digital rectal examination or DRE.
The DRE is done after the blood test for PSA. This is because an exam done within 6 weeks of the blood test can cause the PSA to rise artificially and give a false result.
What is the DRE?
Perhaps this is the part that worries you most about talking to the doctor about your symptoms or concerns. Your doctor will appreciate that and be as kind as possible.
The DRE involves the patient lying on his side while the doctor puts a gloved and lubricated finger (digit) into the rectum. Inside he can feel whether the prostate is enlarged. The exam shouldn't be painful.
You may also be asked for a sample of urine for testing and the doctor may take a blood test to look at your liver and kidney function.
If necessary you may have x-rays taken and scans of the bladder to see what's going on there and how the flow of urine is working. A specialist may also want to take a biopsy of the prostate to check for the presence of cancer cells that will confirm a diagnosis.
Early diagnosis of any cancer is best because treatment is often simpler and more successful. Finding the courage to talk to the doctor can be hard and he will understand that. But for your peace of mind and for that of your family, it's essential.