Prostate Cancer Symptoms

Prostate cancer and breast cancer are similar not only histologically, but also by the fact that both are without symptoms in the beginning. If we wait therefore for symptoms to occur, then we wait until the cancer is incurable. However, since the 1980's all of that changed rapidly with the screening test "prostate specific antigen"(=PSA for short). With this simple blood test anything higher than a value of 5 is suspicious and should be examined and further investigated with a prostate biopsy by a urologist (Ref. 1 and 3). However, Dr. Lee (Ref. 10) pointed out that not only prostate cells produce PSA, but also normal breast tissue, so that one has to be careful when interpreting PSA levels. As an older man has less testosterone and progesterone production, there is a selective process that occurs within the prostate gland allowing abnormal and cancer cells to be more prominent that tend to produce more PSA. PSA has a function of inhibiting angiogenesis, where tumor cells secrete angiogenic factors to create new blood vessels that feed the prostate cancer cells. In overcrowded conditions in the prostate gland such as in benign prostate hypertrophy, but also with prostate cancer, the normal prostate gland cells produce PSA as a defense against the cancer cells that are prolific. These details have to be kept in mind when interpreting PSA results (Ref.10).

The problem is that benign prostatic hyperplasia will also increase the PSA level. Also, occasionally there is a case of a prostate cancer where the cells are so immature histologically that they do not lead to an increase in prostate specific antigen. The PSA test will be normal, but the rectal examination will be abnormal (a hard lump will be palpable to the doctor's examining finger). All of these cases need to be referred to a urologist as a prostate needle biopsy (approach through the rectum) will have to reveal what the underlying diagnosis is. Otherwise, if the patient did not go for his yearly check-up test (rectal exam and PSA test), the cancer will be undetected and exert more and more pressure onto the upper urethra until there is a change in the urinary stream or it comes to an abrupt halt with an acute urinary retention.

This is an emergency and requires a suprapubic catheter to drain the urine and an emergency referral to a urologist. Another symptom may be blood in the urine, well before the bladder obstruction occurs. In this case the upper urethra likely has been invaded by the cancer leading to blood in the urine. There may be a sudden inability to pass urine (urinary obstruction when the prostate cancer obstructs the upper urethra). Even later symptoms are pelvic pain (due to lymph gland metastases), back pains, bone pain (all due to bone metastases), and metastases in other organs such as the lung, the brain, liver or kidneys. Other late symptoms are rapid weight loss, decreased appetite and loss of energy.

Women: tell your man to see his physician once per year for a rectal exam and a blood test to check the PSA level (prostate screening)!

If the PSA level is measured once per year from the 50th birthday onwards, any change to a higher value would become very obvious. See table below:

PSA value:	*Rate of biopsy proven prostate cancer:*
less than 5	4%
between 5 and 10	33%
more than 10	55%

This table makes it obvious why it is important to track the PSA level over the years. But a rectal exam and possible needle biopsies, which by the way can now�be made on a daycare basis or in the office setting of the urologist, are also necessary to complete the screening.

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Prostate cancer

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

The following references were used apart from my own clinical experience:

1. Cancer: Principles &Practice of Oncology, 4th edition, by V.T. De Vita,Jr.,et. al J.B. LippincottCo.,Philadelphia, 1993.Vol.1: Chapter on Prostate cancer.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999.Chapter 233, p.1918-1919.

3. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T.DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on prostate cancer.

4. A Waghray et al. Cancer Res 2001 May 15;61(10):4283-4286.

5. BM Fisch et al. Urology 2001 May;57(5):955-959.

6. CC Parker et al. BJU Int 2001 May;87(7):629-637.

7. B Aschhoff Drugs Exp Clin Res 2000;26(5-6):249-252.

Last Modified: Aug. 26, 2009