What are the signs, symptoms, and causes of prostate cancer?

Prostate Cancer: Signs, Symptoms, and Causes

Prostate cancer in its early stages typically has no identifiable symptoms, which makes screening and early detection crucial for high-risk populations. 1

Signs and Symptoms

Early-Stage Disease

• Early-stage prostate cancer is typically asymptomatic 1
• Many men with prostate cancer may have mild to severe symptoms of lower urinary tract disease due to benign prostatic enlargement, which should not be confused with cancer symptoms 1

Advanced Disease

• Urinary obstruction 1
• Prostatic bleeding 1
• Hematospermia (blood in semen) 1
• Bone pain (indicative of metastatic disease) 1

Risk Factors and Causes

Genetic Factors

• More than 50% of prostate cancer risk is attributable to genetic factors 2
• Multiple family members diagnosed with prostate cancer before age 65 years significantly increases risk 1
• Specific genes have been identified that are linked to hereditary prostate cancer (HPC) 3

Demographic Factors

• Age: Median age at diagnosis is 67 years 2
• Race: Black men have significantly higher risk with an annual incidence rate of 173.0 cases per 100,000 compared to 97.1 cases per 100,000 in White men 2
• Family history: Men with first-degree relatives diagnosed with prostate cancer have increased risk 1

Other Factors

• Hormonal influences play a significant role in prostate cancer development 3
• Diet may exert an indirect influence on prostate cancer risk 3

Diagnostic Considerations

Screening Tests

• Digital Rectal Examination (DRE): Not a substitute for PSA testing but works synergistically with PSA to increase detection sensitivity 1
• Prostate-Specific Antigen (PSA) testing: Primary screening tool, though with limitations 1
  • PSA levels greater than 10 ng/mL confer a greater than 67% likelihood of harboring prostate cancer 1
  • High-grade prostate cancers can be present even with PSA levels below 4.0 ng/mL 1

Diagnostic Confirmation

• Prostate biopsy is required for definitive diagnosis 3
• Multiparametric MRI is increasingly used to improve diagnostic accuracy 4

Clinical Implications

Disease Presentation

• Approximately 75% of patients present with cancer localized to the prostate, associated with a 5-year survival rate of nearly 100% 2
• About 10% of men have distant metastases at diagnosis, associated with a 5-year survival rate of 37% 2

Screening Considerations

• Screening remains controversial with potential benefits of mortality reduction weighed against risks of overdiagnosis and overtreatment 1, 5
• Current guidelines recommend individualized risk-adapted early detection strategies rather than universal screening 4
• Shared decision-making is essential before initiating screening 1

Common Pitfalls in Diagnosis

• Relying solely on PSA cutoff values can miss significant cancers, as high-grade prostate cancers can be present even with PSA levels below 4.0 ng/mL 1
• Confusing symptoms of benign prostatic hyperplasia with prostate cancer symptoms 1
• Failing to consider risk factors such as family history and race when determining screening strategies 1
• Not recognizing that early-stage prostate cancer is typically asymptomatic, potentially delaying diagnosis until advanced stages 1