Cancer Treatment & Information

What are the symptoms of Prostate Cancer?

Most men with prostate cancer have no symptoms. This is particularly true of early prostate cancer.

• Most prostate cancers are discovered incidentally when a digital rectal exam is performed.
• A digital rectal exam is part of a thorough regular health examination. Digital refers to finger.
• During the digital rectal exam, the examiner inserts a gloved and lubricated finger in the rectum to feel the prostate for abnormalities.

Symptoms usually appear when the tumor causes some degree of urinary blockage at the bladder neck or the urethra.

• The usual symptoms include difficulty in starting and stopping the urinary stream, increase in frequency of urination, and pain while urinating.
• The urinary stream may be diminished (urinary retention), or it may simply dribble out.
• Even after urination, there is a sense of bladder fullness because the bladder has not been fully emptied.

Less common symptoms are

• These 3 symptoms are uncommon in early stages of the disease. They usually occur when the cancer is advanced.
• As the cancer advances to cause a greater blockage, bladder function may deteriorate further.
• Men with such advanced cancers sometimes experience recurring urinary tract infections.

Despite these symptoms, many men do not seek medical care until the cancer has spread. Symptoms of metastatic disease include fatigue, malaise, and weight loss. Spread to the bones causes deep bone pain, especially in the hips and back, and bone fractures from weakening of the bone.

How is Prostate Cancer diagnosed?

Prostate cancer is diagnosed from the results of a biopsy of the prostate gland. If the digital rectal exam of the prostate or the PSA blood test is abnormal, a prostate cancer is suspected. A biopsy of the prostate is usually then recommended. The biopsy is done from the rectum (trans-rectally) and is guided by ultrasound images of the area. A small piece of prostate tissue is withdrawn through a cutting needle. The TRUS-guided Tru-Cut biopsy is currently the standard method to diagnose prostate cancer. Classically a 6-core set is taken by sampling the base, apex and mid gland on each side of the gland. More cores may be sampled to increase the yield, especially in larger glands. A pathologist then examines the tissue under a microscope for signs of cancer in the cells of the tissue.

When prostate cancer is diagnosed on the biopsy tissue, the pathologist will then grade each of two pieces of the tissue from 1 to 5 on the Gleason scale. The scale is based on certain microscopic characteristics of the cancerous cells and reflects the aggressiveness of the tumor. The two scores are then added together. Sums of 2 to 4 are considered low, indicating a slowly growing tumor. Sums of 5 and 6 are intermediate, representing an intermediate degree of aggressiveness. Sums of 7 to 10 are considered high, signaling a rapidly growing tumor with the worst prognosis (outcome).

Gleason scores can be helpful in guiding treatment that is based, at least in part, on the aggressiveness of the tumor. The principal application of the Gleason score, however, is in predicting the risk for death from a prostate cancer. The tumor grade strongly affects the prognosis. Higher tumor grades are more frequently associated with lymph node and distant spread (metastases). Thus, recent studies have shown that men with Gleason scores of 2 to 4 face a minimal risk (4 to 7%) of death from prostate cancer over the ensuing 15 years, while men with scores of 8 to 10 face a high risk (60 to 87%) of death from prostate cancer over the 15 year period.

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