10 Early Signs of Prostate Cancer That Often Go Unnoticed
Gerald Hurowitz, M.D.·Published 21 May 2012·8 min read
Key points
Sadly, many men don't find out they have prostate cancer until the cancer has spread, making it more difficult to treat.
This may take the form of feeling like you have to go and then nothing comes out, stopping mid-stream, or having to go more often.
Again, the problem may be a prostate tumor pressing on the urethra.
This sign is less common, but is a reason to go straight to the doctor.
Sadly, many men don't find out they have prostate cancer until the cancer has spread, making it more difficult to treat. This is because in the early stages, prostate cancer often doesn't have many symptoms. That's a problem because prostate cancer is the second most common kind of cancer in American men, after skin cancer.
The good news is, there are signs to be alert for. If you or a man in your life notices any of these changes, it's important to head to the doctor for a checkup sooner rather than later.
Difficulty urinating
This may take the form of feeling like you have to go and then nothing comes out, stopping mid-stream, or having to go more often. Another sign is difficulty stopping, which often takes the form of extended dribbling, or the feeling that you still have to go even when you're done. Because the prostate gland surrounds the urethra—the tube that carries both urine and semen—even a very small tumor in this location can interfere with urination or ejaculation. The prostate gland becomes enlarged in many men as they age, and this enlargement can cause similar urinary problems, as can benign inflammation of the prostate. So there may be no need to worry, but only a doctor can sort out one from the other.
Pain while urinating
Again, the problem may be a prostate tumor pressing on the urethra. However, pain while urinating is also a symptom of infection of the prostate, known as prostatitis, and of benign prostatic hyperplasia (BPH), which is non-cancerous enlargement of the prostate gland.
Blood in the urine
This sign is less common, but is a reason to go straight to the doctor. It doesn't have to be very much blood; all you might notice is a pinkish tint or smear. Some types of urinary tract infections can cause blood in the urine as well, but the doctor will need to perform tests to distinguish.
Difficulty getting or keeping an erection
Yes, this one's really hard to talk about. But if it's not happening when you want it to, or things get stuck "half-mast," it's time for a checkup. (Female partners need to tread delicately around this one, but if it's happening often enough to interfere with your sex life on a regular basis, find a moment to introduce the subject in a kind and non-threatening way.) A prostate tumor can prevent the blood flow increase to the penis that allows an erection to happen, or it can prevent the erection from sustaining to ejaculation. Enlargement of the prostate and BPH can also cause this, so don't panic, but do talk to your doctor.
Blood in the semen
This sign, like blood in the urine (#3) is often not described very clearly. It's not a large amount of blood, more like just enough to make semen pinkish or streaked, according to men with prostate cancer. Gals, you can help with this one too; if you notice an odd color to semen after sex, speak up.
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
What is the chance for a diagnosis of prostate cancer:
For a man in his 40s - 1 in 1000 For a man in his 50s - 12 in 1000 For a man in his 60s - 45 in 1000 For a man in his 70s - 80 in 1000
- Each year in Australia, close to 3,300 men die of prostate cancer - equal to the number of women who die from breast cancer annually. Around 20,000 new cases are diagnosed in Australia every year.
- Each day about 32 men learn news that they have prostate cancer - tragically one man every three hours will lose his battle against this insidious disease
- One in 9 men in Australia will develop prostate cancer in their lifetime
- Prostate cancer is the most common cancer in Australian men and is the second most common cause of cancer deaths in men
- As many men die from prostate cancer as women die from breast cancer but... a national survey by PCFA in 2002 showed that while 78% of women felt well informed about breast cancer – only 52% of men felt informed about prostate cancer
- The chance of developing prostate cancer increases: - - as men get older. - - if there is a family history of prostate cancer eg a man with a father or brother diagnosed with prostate cancer
- Early, curable prostate cancer may not have symptoms. While younger men are less likely to be diagnosed with it, they are more likely to die prematurely from it
- Simple testing by a GP can indicate prostate cancer
- Early detection can be achieved with PSA (Prostate Specific Antigen) blood test or DRE (Digital Rectal Examination) testing. Our research in 2002 shows that only 10% of men surveyed between the ages of 50 and 70 had taken these tests in the previous year.
- Some groups are at greater risk of prostate cancer
- ... for example, for every 100 men who dies of prostate cancer in a metropolitan area of Australia (such as Melbourne or Sydney) 121 men will die in rural Australia. Various factors may include lack of awareness and education about prostate cancer, distance from testing and treatment, poor GP awareness and limited access to specialists (such as urologists)
- The Vietnam Veterans Association of Australia states that veterans have a 53% higher mortality rate from prostate cancer than the average population
- A recently published international study showed that firefighters have a 28% higher risk of prostate cancer
### Prostate Cancer Foundation of Australia
Chronic constipation and other intestinal issues
The prostate gland is located below the bladder and in front of the rectum, so a tumor in this location can interfere with digestive functions. However, it's sort of a chicken-and-egg situation; chronic constipation can contribute to an enlarged prostate by putting pressure on the gland, as well as vice versa. Chronic constipation and intestinal problems can also be an early indicator of colon cancer. A good general rule is, if you're suffering from constipation, gas, or other intestinal symptoms that don't go away when you modify your diet, talk to the doctor.
Frequent pain in the lower back, hips, or upper thighs
The most common sites for prostate cancer to spread are the lower back, pelvis, and hips. Unexplained pain and tenderness in this area is a sign of trouble. One way to distinguish this type of pain from run-of-the-mill sciatica and lower back pain is that it may feel deeper and more like a dull ache. However, experts say any lower back or hip pain that doesn't go away is a reason to see the doctor.
Having to pee in the middle of the night
This is one of the sly symptoms that men diagnosed with prostate cancer say they now look back and remember. If you find yourself waking more than once a night urgently needing to go, a trip to the doctor and a PSA test is in order.
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Leaking or dribbling urine
Here's one almost no one talks about, but we need to. It's basically the male version of urinary incontinence, which typically occurs on a small but still noticeable scale. Longer bathroom trips while you wait for the dribbling to stop or leakage on the way to the bathroom are the telltale signs. Women, if while doing the laundry you notice that his pants or jeans smell like pee, delicately suggest a visit to the doctor.
You're over 50 and have risk factors
Since early prostate cancer most often has no symptoms at all, men who are at risk need to talk to their doctors and have regular PSA tests and rectal exams (sorry!) whether they notice anything odd happening or not. Family history - especially a father who had prostate cancer - being overweight, eating a high-fat diet, being of African-American descent, and smoking all increase your risk of prostate cancer. Another one many men don't know: If the women in your family have a history of breast cancer, you may carry faulty genes that increase your prostate cancer risk.
Diagnostic tests are limited
We always knew that prostate cancer is common and that, until recently, it often went undiagnosed: Autopsies of men who died of other causes have shown that about one-third of men over age 50 have some cancerous cells in their prostate, while 90% of men over age 90 have such cells.
As PSA screening has grown more widespread, we are finding more tumors that otherwise would have escaped detection. Yet current diagnostic technology does not always enable urologists to determine which tumors will lie dormant and which will become active, spreading elsewhere in the body.
Studies estimate that anywhere from 16%–56% of men diagnosed with prostate cancer, generally because of an abnormal PSA test, have tumors that might never have caused problems had they not been found. And the landmark Prostate Cancer Prevention Trial (PCPT) unexpectedly yielded data that early-stage prostate tumors are incredibly common, even at PSA levels considered normal.
The PCPT was a randomized controlled study - the type considered to be the gold standard in research. The study, which involved almost 19,000 healthy men, was designed to evaluate whether the drug finasteride (Proscar) could prevent prostate cancer from developing. Finasteride is a hormonal medication originally approved to treat benign prostatic hyperplasia (an enlarged prostate, which can cause problems with urination), but which has also been investigated as a potential treatment for prostate cancer.
All participants were ages 55 and older with PSA levels of no more than 3.0 nanograms per milliliter (ng/ml) and normal digital rectal exams - in other words, by the traditional testing standards, they showed no evidence of prostate cancer. Investigators randomly assigned participants to take finasteride or a placebo, and the men were followed for seven years. Every year, all participants underwent a digital rectal exam and had their PSA levels tested.
Every participant in the PCPT also agreed to undergo a prostate biopsy at the end of the study, whether he met the clinical criteria for such a biopsy or not. The reason investigators included this requirement was that they wanted to eliminate any "detection bias," a technical term for unintended differences in diagnosis between comparison groups in a study - in this case, between the men randomly assigned to finasteride and those assigned to receive placebo.
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