Symptoms and DiagnosisMost cancers in their early, most treatable stages don't cause any symptoms. Early prostate
Cancer usually does not cause symptoms.
However, if prostate cancer develops and is not treated, it can cause these symptoms:
- a need to urinate frequently, especially at night
- difficulty starting urination or holding back urine
Possible symptoms of prostate cancer:- inability to urinate
- weak or interrupted flow of urine
- painful or burning urination
- difficulty in having an erection
- painful ejaculation
- blood in urine or semen
- Pain or stiffness in the lower back, hips, or upper thighs.
Any of these symptoms may be caused by cancer, but more often they are due to enlargement of the prostate, which is not cancer. If you have any of these symptoms, see your doctor or a urologist right away to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system.
The doctor will ask questions about your medical history and perform a digital rectal exam to try to find the cause of the prostate problems. In this exam, the doctor feels the prostate through the rectal wall. Hard or lumpy areas may mean cancer is present.
The doctor may also suggest a blood test to check your prostate specific antigen, or PSA, level. PSA levels can be high not only in men who have prostate cancer, but also in men with an enlarged prostate gland and men with infections of the prostate. PSA tests may be very useful for early cancer diagnosis. However, PSA tests alone do not always tell whether or not cancer is present.
Neither of these screening tests for prostate cancer is perfect. Screening tests check for disease in a person who shows no symptoms. Most men with mildly elevated PSA do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. A recent study revealed that men with low prostate specific antigen levels, or PSA, may still have prostate cancer. Also, the digital rectal exam can miss many prostate cancers.
The doctor may order other exams, including Ultrasound and X-Rays, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a Biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope.
If a biopsy shows that cancer is present, the doctor will report on the grade of the Tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.
One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors.
Planning Treatment
If tests show that you have cancer, you should talk with your doctor in order to make treatment decisions.
A team of specialists often treats people with cancer. The team will keep the primary doctor informed about the patient's progress. The team may include a medical Oncologist who is a specialist in cancer treatment, a surgeon, a Radiation oncologist who is a specialist in Radiation Therapy, and others.
Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it.
Some prostate cancer patients take part in studies of new treatments. These studies -- called Clinical trials -- are designed to find out whether a new treatment is safe and effective.
Staging Prostate Cancer
If cancer is found in the prostate, the doctor needs to know the stage of the disease and the grade of the tumor. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. The grade tells how closely the tumor resembles normal tissue in appearance under the microscope.
Doctors use various blood and imaging tests to learn the stage of the disease. Imaging tests, such as ultrasound and Magnetic resonance imaging, or MRI, produce pictures of images inside the body.
There are four stages used to describe prostate cancer. Doctors may refer to the stages using the Roman numerals I-IV or the capital letters A-D. The higher the stage, the more advanced the cancer. Following are the main features of each stage.
Stage I or Stage A -- The cancer is too small to be felt during a rectal exam and causes no symptoms. The doctor may find it by accident when performing surgery for another reason, usually an enlarged prostate. There is no evidence that the cancer has spread outside the prostate. A sub-stage, T1c, is a tumor identified by needle biopsy because of elevated PSA.
Stage II or Stage B -- The tumor is still confined to the prostate but involves more tissue within the prostate. The cancer is large enough to be felt during a rectal exam, or it may be found through a biopsy that is done because of a high PSA level. There is no evidence that the cancer has spread outside the prostate.
Stage III or Stage C -- The cancer has spread outside the prostate to nearby tissues. The person may be experiencing symptoms, such as problems with urination.
Stage IV or Stage D -- The cancer has spread to Lymph nodes or to other parts of the body. The bones are a common site of spread of prostate cancer. There may be problems with urination, Fatigue, and weight loss.
