Prostate Cancer Symptoms

What Is Prostate Cancer?

The prostate gland is only found in males and is located below the bladder. When cell growth exceeds its optimal range, the excess cells become malignant, leading to prostate cancer [¹]. Generally, the prostate gland has the size of a walnut in young males. However, the gland size changes (becomes larger) with age.

Types of Prostate Cancer

Prostate cancer can be classified into different types based on cancer characteristics. Typically, all prostate cancers are adenocarcinomas [²]. Such cancers develop due to cell growth (cells responsible for making fluid that makes up a part of the semen) in prostate glands. While true, a few other prostate cancer types may occur.

• Small cell carcinoma
• Transitional cell carcinoma
• Neuroendocrine tumors
• Sarcomas

How Is Prostate Cancer Diagnosed?

Doctors use a biopsy to diagnose different types of cancers. So is the case with prostate cancer. When you notice prostate signs or symptoms, your doctor may run a few checks before proceeding to a biopsy. A biopsy removes a small piece of tissue from the prostate gland and examines it under a microscope. A Gleason score [³] (a scale of 1-10) determines if cancer will likely spread. The lower the score, the lesser chance that it will spread. Doctors evaluate the patient’s condition (after a biopsy) when diagnosed with cancer.

Prostate Cancer Staging

Determining the prostate cancer stages requires a thorough examination of the cells. To understand staging, it is crucial to know the TNM system.

• T (tumor) shows the tumor size, exact location, and tissue depth.
• N (node) describes whether malignancy (in cells) has spread to nearby lymph nodes or connecting channels.
• M (metastasis) shows if malignant cells have spread to other tissues or organs.

Stage I

• It is the earliest prostate cancer stage with slow growth.
• The tumor cannot be felt and affects one-half of a single prostate (gland) side (or even less).
• PSA levels are low (less than 10) [⁴].
• The malignant cells look like normal (healthy) cells. [⁵].

Stage II

• The tumor is still in the prostate gland.
• PSA levels are low-medium.
• The tumor is small but has an increased risk of growth and spreading.

Stage II prostate cancer further classifies as

IIA

• The tumor cannot be felt and involves half of a single gland side (or lesser).
• PSA levels are medium (10 or above but less than 20) [⁶].
• Malignant cells are well differentiated.

IIB

• The tumor is only restricted inside the gland and may be felt during a DRE [⁷].
• PSA levels are medium (less than 20) [⁸].
• Moderately differentiated malignant cells.

IIC

• The tumor is restricted inside the prostate gland and may be felt during a DRE.
• PSA levels are medium (less than 20).
• Poorly or moderately differentiated malignant cells.

Stage III

• It is a relatively advanced stage of prostate cancer.
• The tumor growth is higher (locally advanced cancer).
• Higher PSA levels.

Stage III cancer further classifies as

IIIA

• The tumor has spread into the outer prostate gland layer and might be felt during a DRE.
• PSA levels are higher (at least 20) [⁹].

IIIB

• The tumor has spread outside the prostate gland, invading nearby parts (seminal vesicles, bladder, or rectum).
• PSA levels may vary (for each case).

IIIC

• Poorly differentiated (different from healthy cells) cancer cells.
• PSA levels may vary (for each case).

Stage IV

When diagnosed with cancer at the fourth stage, the tumor spreads outside the prostate gland, affecting nearby parts and connective tissues (lymph nodes). Stage IV prostate cancer further classifies as

IVA

• The tumor has spread to nearby lymph nodes.
• PSA levels may vary (for each case).

IVB

• The tumor spreads to distant body parts (lymph nodes, organs, or bones).
• PSA levels may vary (for each case).

Is Prostate Cancer Hereditary?

Prostate cancer can be inherited. However, most cases occur without a family history. Having said that, a male with a brother or father diagnosed with cancer (prostate) has a much-increased risk of developing prostate cancer. The hereditary risk is much higher for males who have a brother with the disease [¹⁰].

Moreover, the risk of developing internal cancer (like prostate cancer) is much higher in those with several cases in relatives.

Prostate Cancer Symptoms

Prostate cancer can be devious in many males due to the nature of its symptoms. Prostate cancer often goes undiagnosed due to a lack of disease-related symptoms [¹¹]. Having said that, many indicators can help you identify a problem with your prostate gland. Understanding the symptoms can help you track the development of malignant cells in the early stages. Here are a few common symptoms of prostate cancer.

• Difficulty in urinating
• Interrupted (or weak) urine flow
• Frequent urination (especially at night)
• Difficulty emptying the bladder
• Burning or painful urination
• Blood in urine and/or semen
• Recurring pain in the back, hips, or pelvis
• Painful ejaculation

Please note that these conditions may be caused by other health conditions. Consulting a doctor for diagnosis can help you dig into the cause.

What Are the Symptoms of Prostate Cancer?

Prostate cancer symptoms might vary depending on the stage of diagnosis. While the common symptoms cover the above-listed factors, they can be further classified into urination symptoms and body responses when in metastasis. Let’s dive into the details for a better understanding.

Urinary Symptoms

As prostate cancer advances, the symptoms may appear as obvious signs in most male adults. The tumor spreads beyond the gland in advanced stages and affects the urinary tract. More often, adults with advanced prostate cancer stages face bladder congestion and urination troubles. We have listed these symptoms below to give you an idea [¹²].

• Burning sensation when urinating
• Trouble starting or stopping the urination
• Frequent urination urges during the night
• Little or no control over the bladder
• Decreased or interrupted urine flow
• Blood-mixed urine stream
• Erectile dysfunction

While these urinary symptoms of prostate cancer may go unnoticed in many males, a DRE and PSA monitoring may identify these issues (based on the cancer stage).

Metastatic Prostate Cancer Symptoms

In advanced stages, prostate cancer may cause additional symptoms in adult males. As the tumor spreads beyond the prostate gland, it starts developing on lymph nodes, other organs, and bones. The malignancy affects the healthy function of other body parts and causes disruptions. We have classified the metastatic prostate cancer symptoms into different sections of the body for a thorough understanding.

Symptoms of Prostate Cancer Spreading to the Bones

Metastatic prostate cancer can spread to the bones and affect the spine, pelvis, skull, and ribs [¹³]. Patients may notice bone pain (typically when waking up or at night). Moreover, patients in the advanced stages may become weaker and have fragile bones (likely to be fractured easily). If spread to the spine, prostate cancer cells can cause spinal cord compression.

Symptoms of Prostate Cancer Spreading to the Lymph Nodes

Advanced prostate cancer can spread to the regional lymph nodes (in the pelvic area) and lead to symptoms like pain and swelling (in the affected areas) [¹⁴]. Since malignant cells stop lymph nodes from draining fluids, patients may notice swollen legs due to excess fluid.

Symptoms of Prostate Cancer Spreading to the Liver

Metastatic prostate cancer can spread to distant body organs, including the liver. When malignant cells affect the liver, patients may notice discomfort on the right abdominal side. Other symptoms include weight loss, poor appetite, swollen tummy, jaundice symptoms, and itchy skin [¹⁵].

Symptoms of Prostate Cancer Spreading to the Lungs

If cancer cells spread to the lungs, patients may notice a recurring cough, shortness of breath, recurring chest infections, blood coughs, and fluid development between the chest and the lungs [¹⁶].

What Are Some Signs of Prostate Cancer?

Since prostate cancer often remains undetected, healthy males opt for screenings tests to identify general signs beforehand. Periodic testing allows patients to track their prostate health history. For your ease, we have covered the common clinical signs of prostate cancer below.

Prostate-Specific Antigen (PSA) Test

A general sign of prostate cancer is the PSA level in prostate cells. Prostate-specific antigen (PSA) is a protein formed by cells present in the prostate glands. Although mostly found in semen, some PSA is also in the blood. Measured in nanograms per milliliter (ng/mL), the PSA level is an obvious sign to detect prostate cancer.

Most doctors set the cutoff point of 4 ng/mL (or higher) to decide if a male should be subjected to further testing. We have listed different PSA ranges below for a thorough understanding.

PSA Level Under 4 ng/mL: Most males with a PSA value over 4 are diagnosed with prostate cancer. However, having a lower (than 4) value does not guarantee the absence of a tumor.

PSA Level Between 4 and 10: Males with PSA between 4 and 10 are in the borderline range. Such patients may have one in four chances of developing prostate cancer.

PSA Level Over 10: Males with a PSA value over 10 have an increased chance (over 50%) of having prostate cancer [¹⁷].

Digital Rectum Exam (DRE)

A digital rectum exam (DRE) is another screening test to verify the signs of prostate cancer. This physical exam involves inserting a lubricated finger (with gloves) into the rectum to feel a cancerous lump. Typically, a bump or hardness (in the rectum) is an obvious sign of malignancy in the prostate gland. A DRE (usually) takes a short time and may be painful for males with hemorrhoids.

Although a DRE is less effective than the PSA test, it can detect prostate cancer signs in males with normal PSA levels.

Biopsy

If a doctor prescribes the patient for further testing (after checking PSA or DRE reports), the next stage is a biopsy. A biopsy determines the condition and growth of a tumor in a particular body part (a prostate gland in this case). Doctors conduct a biopsy by taking a part of a prostate tissue and examining it under a microscope. The examination of the affected tissue helps to evaluate the cancer stage.

Risk Factors for Prostate Cancer

Prostate cancer risk factors cover a few pointers that males should keep in mind to ensure good health. The established risk factors include age, race, and family history. However, other factors, such as diet influences, can also risk prostate health.

Risks Associated With Races: The incidence rate of prostate cancer for African-Americans is nearly 60 times higher than for males in China. Similarly, Japanese Americans have an incidence rate 43 times higher than males in Japan [¹⁸]. Research shows that diet and other factors increase prostate cancer in males living in the U.S.

Risks Associated With Diet: Since Western males eat foods with higher calories and fat, the chances of developing prostate cancer increase in Western males. Although the correlation indicates a small positive association, consuming saturated fats (fat coming from animals) increases the risk of developing the disease [¹⁹].

Prostate Cancer Prevention: While prevention of prostate cancer can be difficult due to most causes being natural, some healthcare experts advise prostate cancer patients to add foods rich in folate, finasteride, and dutasteride, to minimize the risk of developing malignancy [²⁰].

Prostate Cancer Prognosis and Treatment

The prognosis for prostate cancer highly depends on the stage and type of prostate cancer. Generally, prostate cancers diagnosed at early stages have a better chance of recovery. If cancer metastasizes, the treatment becomes more difficult. However, prostate cancer patients should maintain hope in all cases.

Doctors may prescribe different treatments, including therapies, to prostate cancer patients. Sometimes, doctors advise patients to wait on the treatment when diagnosed in the early stages. Patients may closely monitor the symptoms of prostate cancer and report to the doctor if they notice any.

Prostate Cancer Survival Rate

Generally, the prostate cancer survival rate is higher on the 5-year survival analysis. The SEER database maintained by the National Cancer Institute (NCI) thoroughly provides information on the survival statistics for different cancer types. According to these findings, localized prostate cancer has over 99% survival, regional malignancy also has over 99% survival rate, distant malignancy has a 32% survival, and collectively (all SEER stages), prostate cancer has a 97% survival rate [²¹].

Prostate Cancer Treatment Options

Prostate cancer treatment depends majorly on the type and stage of diagnosis. Doctors decide the path to treatment with the patient’s consent. We have covered the common treatments below for your understanding [²²].

• Surgical removal of the prostate and surrounding tissues
• Radiation therapy (external or internal) to kill malignant cells
• Cryotherapy for freezing and killing malignant cells
• Chemotherapy for ingesting or injecting special drugs to kill cancer cells
• Biological therapy to control side effects of other cancer treatments and boost immunity
• High-intensity ultrasound to kill cancer cells with high-energy sound waves
• Hormone therapy for blocking malignant cells from getting hormones (for cell growth)

Conclusion

Takeaway

Prostate cancer can be challenging to diagnose due to its less-obvious symptoms in many patients. While valid, going for screening tests on a periodic schedule can help you detect them in the early developmental stages. You may consult your doctor immediately for diagnosis if you notice any recurring symptoms (as mentioned in the article).