Signs are physical changes that can be detected by anybody. They may include such things as swelling, smell (odor), sensitivity to touch, and abnormal test results.
Symptoms are discomforts that are normally known only to the patient: e.g., pain, nausea, and a burning sensation when you urinate.
Most signs and symptoms are not specific to any one medical condition. For example, redness of the eyes can be from allergies or a bad hangover; abdominal pain can be from gallstones or a bad case of indigestion.
Diagnosis of any disorder always begins with an evaluation of many signs and symptoms. With prostate cancer, we rely on signs and symptoms to suggest but not to establish diagnosis.
There are no signs or symptoms of prostate cancer which can be easily assessed by the patient himself. This makes prostate cancer very different from breast cancer or testicular cancer, in which regular self examination can be important in finding early signs of the disease.
Here is a very important point: early stage prostate cancer causes no symptoms. BUT … just because you have no symptoms does not mean that there is no cancer. You can have a potentially life threatening, early stage prostate cancer even if you have no symptoms.
By comparison, late stage prostate cancer can and commonly does cause symptoms. For example, late stage prostate cancer can cause severe need to urinate (“urgency”), and if it involves the bones of the spine, prostate cancer can cause terrible pain.
Despite the fact that prostate cancer has no definitive set of symptoms, all of the following have been identified by the National Cancer Institute as possible indicators of prostate cancer — and of many other clinical problems:
- Needing to urinate often (especially at night)
- Not being able to urinate
- Trouble starting to urinate or trouble holding back urination
- A weak or interrupted urine flow
- Pain or a burning feeling during urination
- Difficulty having an erection
- Pain during ejaculation
- Blood in the semen or in the urine
- Frequent pain or stiffness in the lower back, hips, or upper thighs.
So Why Would You Go See the Doctor?
An important clinical goal for you and your doctor should be to detect risk for prostate cancer long before it can cause symptoms.
Thus, any initial detection of signs that you may have prostate cancer is now most commonly the result of a regular check-up carried out by your primary care physician, which may include a digital rectal examination (DRE) or a prostate specific antigen (PSA) test.
The most common symptom which may make a man go to either his primary care physician or a urologist, and which might subsequently lead to a diagnosis of prostate cancer, is some form of problem with normal urination.
Since all the symptoms listed above may be caused by prostate cancer and/or by a number of other disorders (and not just other disorders of the prostate), it would be wise to talk to your family doctor if you or someone else in your family is having one or more of these problems on a regular basis.
Signs of Prostate Cancer Your Doctor Can Assess
Your doctor can tell a lot about your prostate by the way that it feels.
The back (“posterior”) wall of your prostate is very close to your rectum. If your doctor inserts a finger into your rectum, he can feel the back and sides of your prostate through the thin, soft wall of the rectum. This examination of the prostate is called a digital rectal examination (DRE) (see Figure 1).
The DRE is used to detect possible signs of prostate illness:
- A DRE that finds a smooth, soft prostate but that causes intense pain is commonly a sign of prostate infection, also known as prostatitis.
- A DRE that finds a smooth, rubbery, and enlarged prostate is commonly a sign of prostate enlargement, also known as benign prostate hyperplasia.
- A DRE that finds hard nodules, generalized firmness, or an unusual shape to the prostate is commonly a sign of prostate cancer.
DRE can be used to raise suspicion of prostate cancer. DRE can not be used to rule out prostate cancer.
Many prostate cancers produce no physical signs that can be felt by DRE. In other words, a normal DRE is not a sign that there is no prostate cancer.
It is also well known that if different doctors carry out a DRE on the same patient (even on the same day, one immediately after the other), they may come to different decisions about what they think they feel.
Figure 1: How the DRE is carried out.
Because physical examination with DRE is not always helpful, there is great interest in laboratory tests that can be used to measure things in the blood and the urine. Many such tests have been developed. The most widely known and studied is a test known as the prostate specific antigen or PSA test. PSA is a normal protein produced in the prostate and found at high levels in your semen. It is also normally found at very low levels in the blood.
In many men with prostate cancer, the normal barriers that limit the amount of PSA that can get into the bloodstream are damaged and higher amounts of PSA can “leak” from the prostate into the blood. For these reasons doctors often refer to PSA as a “marker” for prostate cancer.