Prostate cancer is the most common malignant tumor in males. It is more common as we age, but the age of the onset is highly variable.
If you have many risk factors, you could develop prostate cancer at an early age. But how do you know? Some people think that they should get screened for prostate cancer every year after 40 or 50 years old. But that is based on outdated data. In the current medical practice, there’s no reason to do that if you’re not at risk or have symptoms.
As such, paying attention to warning signs of prostate cancer is fundamental for its diagnosis. In this article, we’re reviewing the most acute symptoms of prostate cancer.
They can be useful as a warning that we should get screened or checked by a urologist. If you have one of them or more, we’re also telling you what steps to take and what’s happening after that.
What is prostate cancer?
Prostate cancer is a malignant growth of cells in the prostate. It is a tumor located in the prostate gland. In a malignant tumor, prostate cancer cells lose their differentiation and characteristics. They activate cell division at an accelerated pace and have no self-restraint. As a result, the prostate grows and keeps growing over time, causing urinary obstruction and other problems.
Unlike breast cancer and other types, prostate cancer is not always aggressive or lethal. Only 1 in 6 White males are diagnosed with prostate cancer in their lifetime. The number is higher in men of African American origin (1 in 5 men). And the number of cases that remain without a diagnose is even higher than that.
In some cases, the onset of prostate cancer is at an advanced age. Since the disease progresses relatively slowly, the cancer death in these patients is more likely to be from other causes. However, advanced prostate cancer is not rare and can be very dangerous (1).
For some time, males were prompted to screen for prostate cancer every year. This was meant to detect this problem earlier and provide a rapid response to prostate disease. But recent studies showed that a yearly measure has multiple drawbacks. Doctors were detecting more cases in patients who had a low risk of aggressiveness.
Some of them never required radical prostatectomy or any other prostate cancer treatment, but they were left out with prostate biopsies’ severe side effects. There was also an excessive number of unnecessary biopsies being made. With that, a significant number of patients experienced side effects unnecessarily, affecting their quality of life (2).
In today’s medicine, doctors and patients need to pay more attention to their risk factors instead of a fixed age to start prostate cancer screening yearly. In some cases, screening every year is recommended, even if you don’t have prostate cancer symptoms. In other patients, it is not performed, and screening every year is entirely off the table. Warning signs of prostate cancer can be a useful indication to know that you belong to the first group, and screening might be appropriate for you.
What are the 5 warning signs of prostate cancer?
Prostate cancer mainly has urinary symptoms, as you will see in this list. They are usually the earliest symptoms reported by patients. Others start adding up as the tumor becomes more extensive, especially after the disease spreads to distant organs.
But let’s stay in early prostate cancer and list the top 5 warning signs. Some of them are not found in an early stage but are sometimes the first alarm sign that leads patients to the urologist office (3):
1) A painful or burning sensation during urination or ejaculation
This is typically known by doctors as dysuria. It is a common symptom in a lower urinary tract infection. However, urinary infections in males are not as common as in females.
Moreover, this burning or painful sensation is felt over a long period and not all of a sudden. Thus, instead of thinking that this symptom is due to a urinary infection, it is appropriate to talk to your doctor about it. Do not neglect this type of urinary symptoms because they can be a sign of something bigger.
Some patients neglect their urinary symptoms because they are not very severe. But their symptoms keep on becoming worse over time. If they do so at a slow rate, patients may even get used to the increasing severity. Thus, they do not report what they feel and may not know it is a sign of prostate cancer.
In the beginning, it could be a sensation of weight or discomfort instead of actual pain. Then, it is often accompanied by other symptoms listed below.
2) Frequent urination, particularly at night
Frequent urination at night is a symptom called nocturia in a doctor’s jargon. It is actually one of the earliest symptoms that patients with prostate cancer report. Waking up at night to urinate is uncommon in young males, but it is not alarming.
When this happens every night, it can be attributed to the patient’s habits and moderate prostate growth. But waking up twice or three times every night should be an alarm sign for men, especially after 50 years old.
Urinary frequency also increases throughout the day. Patients may need to use the bathroom very often, which becomes a problem when they go out. This symptom should be closely monitored in some patients with a voiding diary. In this diary, patients input how much water or other liquids they are taking. They also input the number of times they go to the bathroom and the hour. This way, we can differentiate when patients are only drinking too much water. It is also useful to give doctors clear and accurate data instead of an approximate number by memory recall.
Urination becomes more frequent because prostate enlargement presses upon the urethra. The available space becomes reduced, and the bladder needs to push harder to urinate. There’s a pressure change in the bladder, and it will only void partially, leaving the remaining volume of urine accumulating. So, it fills once again more rapidly, triggering the urge to urinate.
3) Difficulty stopping or starting urination
This is also an essential sign of prostate enlargement. As noted above, the enlarged prostate is wrapped around the urethra. As it grows, the prostate gland presses upon the urethra and causes partial obstruction. This is also known as bladder outlet obstruction, and it is often not severe. However, it affects the quality of life and becomes bothering and quite annoying.
Patients feel the need to push very hard to start urinating. This is also known as urinary strain. They take a very long time to start urinating, which is known as urinary hesitancy. These patients may also feel difficult to maintain a continuous flow of urine. Instead, they start and stop urinating several times to continue voiding. This is also known as urinary intermittency. The flow of urine is weaker, so they take a long time to urinate and usually experience dribbling at the end of voiding.
These symptoms can be summarized in a few words: patients have urinary difficulties as perceived in their urinary flow. This is a very important sign of prostate enlargement, which can be BPH or prostate cancer.
4) Sudden erectile dysfunction
Erectile dysfunction is a very long topic of discussion in patients with prostate cancer. But at the earliest stage of the disease, it is not the most common symptom we will find.
Patients with erectile dysfunction in the early stages of prostate cancer most probably have a psychological cause of sexual problems. Prostate enlargement will rarely affect the proper filling of the corpus cavernosum to achieve an erection.
At a later stage of the disease, erectile dysfunction becomes one of the symptoms of prostate cancer. It happens when a prostate cancer tumor becomes more aggressive. The tumor has already grown very big, and it is now starting to spread outside of the prostate.
When it spreads to the corpus cavernosum and other erectile structures, erectile dysfunction is more common. At this stage, prostate cancer patients usually have a display of moderate or severe urinary symptoms. Still, erectile dysfunction is sometimes what prompts patients to visit the urologist.
This symptom is even more common after diagnosing and treating prostate cancer: surgery and other prostate cancer treatments cause temporary erectile dysfunction. In most cases, this symptom is successfully treated after surgery. But it takes a few weeks or months to experience full recovery of the erectile function.
5) Blood in urine or semen
Bleeding is a common symptom in many types of cancer, including prostate cancer. Cancer cells divide rapidly and create new tissue that grows very large. If they do not create new blood vessels, the excess tissue will die from starvation. Thus, they trigger something called angiogenesis, that is, new blood vessel creation.
These blood vessels are abnormal, often fragile, and prone to bleeding. Plus, we have inflammation in prostate cancer. There are more blood vessels, and they increase their blood flow due to inflammation.
The urine goes through the prostatic portion of the urethra. The prostate gland partly releases the seminal fluid. Thus, there’s a clear rationale as to why patients with prostate cancer notice blood in the urine and semen. However, this sign is unlikely to be the first one to show up in a patient with prostate cancer.
Males with blood in the semen due to prostate cancer usually had previous urinary symptoms described above. In some cases, they neglected their condition, attributed the disease to something “normal” as we age, or got used to the symptoms and didn’t realize their progression.
What should I do if I have prostate cancer symptoms?
If you have one or more symptoms listed above, you need to talk to your doctor about it. Remember that an early sign of prostate cancer does not mean that you have the disease.
Even a big mass on your prostate that looks like cancer might be benign prostatic hyperplasia. But patients are not the ones who decide that. Not even doctors do it after a quick glance. Diagnostic tests and their interpretation are what give doctors enough tools for the diagnosis and treatment of cancer.
After communicating your concern to your urologist, he might recommend a few tests. The most common include a PSA test and a digital rectal examination. In some cases, transrectal ultrasonography is also recommended.
After gathering all of this information and keeping your risk factors in mind, your doctor will decide if you’re a candidate for a prostate biopsy to obtain a Gleason score. This is sometimes a very clear decision in high-risk patients, but some of them are in the “gray area.” In that case, more tests may be required before deciding on a prostate biopsy (4).
In some cases, patients with symptoms of prostate cancer are only given supportive therapy. This usually happens to the elderly who do not have an extensive life expectancy. In this matter, every case should be evaluated individually, and only a trained specialist is suitable for the job.
What are the 5 warning signs of prostate cancer? They include a painful or burning sensation when urinating or ejaculating, frequent urination (particularly at night), difficulty stopping or starting urination, erectile dysfunction, and blood in the urine or semen.
These symptoms are useful for an early diagnosis of the disease. They should be evaluated along with other risk factors to decide when a patient needs a measure of the Prostate-Specific Antigen (PSA testing), a rectal exam, and other screening methods.