From the Guidelines
Prostate cancer often causes no symptoms in its early stages, which is why regular screening is important for men over 50 or those at higher risk, as stated in the guidelines by the National Comprehensive Cancer Network 1. When symptoms do appear, they typically include:
- Difficulty urinating
- Weak or interrupted urine flow
- Frequent urination (especially at night)
- Blood in urine or semen
- Pain or burning during urination
- Discomfort in the pelvic area Some men may experience pain in the lower back, hips, or upper thighs if the cancer has spread beyond the prostate. These symptoms aren't specific to prostate cancer and can also be caused by benign conditions like benign prostatic hyperplasia (BPH) 1. If you experience any of these symptoms, you should consult a healthcare provider promptly for evaluation, which may include a digital rectal exam, PSA blood test, and possibly imaging or biopsy. Early detection significantly improves treatment outcomes, as prostate cancer is highly treatable when caught early, as supported by the U.S. Preventive Services Task Force recommendation statement 1. The prostate's location around the urethra explains why urinary symptoms are common, as the growing tumor can press against this tube and interfere with normal urinary function. It is essential to consider the risks and benefits associated with the early detection and treatment of prostate cancer, including the potential for overdiagnosis and overtreatment, as highlighted in the guidelines and studies 1.
From the Research
Prostate Cancer Symptoms
Prostate cancer symptoms can be detected through various methods, including digital rectal examination (DRE) and prostate-specific antigen (PSA) testing.
- The study 2 discusses the roles of DRE, PSA, and transrectal ultrasonography in diagnosing early prostate cancer, highlighting the importance of early detection and treatment for optimizing the potential for cure.
- Another study 3 found that the combination of PSA and DRE improves the stage of diagnosis of patients with prostate cancer, with a sensitivity of 75% and specificity of 87% for PSA, and a sensitivity of 75% and specificity of 69% for DRE.
Detection Methods
The detection methods for prostate cancer symptoms include:
- Digital rectal examination (DRE): a study 4 found that PSA detected significantly more tumors (82%) than DRE (55%), with a cancer detection rate of 3.2% for DRE and 4.6% for PSA.
- Prostate-specific antigen (PSA) testing: a study 5 found that the pooled positive predictive value of PSA was 0.22, similar to that of DRE (0.21), with no benefit from combining DRE and PSA.
- Transrectal ultrasonography (TRUS): a study 2 found that TRUS is more costly and does not add appreciable detectability when results of both DRE and PSA determination are normal.
Screening Strategies
The screening strategies for prostate cancer symptoms include:
- Combining DRE and PSA: a study 4 found that the use of PSA in conjunction with DRE enhances early prostate cancer detection, with a cancer detection rate of 5.8% for the combined methods.
- Using PSA alone: a study 5 found that the screening strategy combining DRE and PSA was not different from that of PSA alone in terms of cancer detection rate and positive predictive value.
- Omitting DRE from screening strategies: a study 5 suggests that DRE could be potentially omitted from prostate cancer screening and early detection strategies, given its low diagnostic value.
- A study 6 found that the positive predictive value of a suspicious digital rectal examination was appreciable in men with low serum PSA, with a cancer detection rate of 13% in men with PSA 4 ng./ml. or less and suspicious DRE findings.