Prostate Cancer Symptoms

This article describes symptoms that can occur from the prostate gland.  The prostate gland is only found in men and is positioned under the bladder.

The healthy prostate gland has several important functions.  The prostate gland allows passage of urine out of the bladder through the urethra.  The urethra is the drainage tube from the bladder.  Most of the urethra is found in the penis but a short segment passes through the prostate gland.  The prostate serves key functions in reproduction as it secretes fluid that contributes to semen.  This fluidis alkaline (i.e. has a high pH >7) and also serves as a carrier or lubricant for sperm.  This alkaline fluid aids sperm in surviving their potential journey to a female ovum for fertilization.  The normal prostate is about 18 grams and is about 2 x 4 cm.  The prostate gland functions and grows under the direction of male sex hormones (a derivative of testosterone).  The prostate also secretes a small protein that can be found in the blood known as PSA (prostate specific antigen).  Interestingly, this protein can be found in other bodily fluids but it is still fairly specific for the prostate gland.

The prostate gland is of interest to men’s health for several reasons.  A healthy prostate contributes to proper urinary excretion, kidney function, and reproductive/sexual functions.  Cancer of the prostate is the most common type of cancer diagnosed in men, besides minor skin cancers.

The top 10 most common cancers diagnosed in men in the United States from 2003-2007.

The top 10 most common causes of death from cancer in men in the United States from 2003-2007.

As noted above, prostate cancer is the most common cancer diagnosed in men and the second most common cause of death from cancer for men in the United StatesLung cancer still remains a much bigger threat to a man’s health and is largely attributed to smoking.  This emphasizes the importance of education about the dangers of cigarette smoking.

Many prostate problems cause similar symptoms.  Some prostate diseases may not have symptoms at first such as prostate cancer.  This is why screening tests such as the rectal examination (DRE – digital rectal exam) and the PSA blood test are important for men’s health.  The DRE and PSA tests do not confirm the presence of prostate cancer, but if they are abnormal this should prompt further investigation to see if cancer is present.  This is often done with needle biopsies and some type of imaging tests such as an ultrasound or CT scan.

Common symptoms of prostate disease include:

  • Urinary Retention
  • Nocturia
  • Urinary Frequency
  • Urinary Straining
  • Urinary Intermittency
  • Pain above the pubic bone
  • Pain in the pelvis
  • Difficulty with erection or sexual function
  • Painful ejaculation
  • Dysuria (painful urination)
  • Hematuria (blood in the urine – either microscopic or brightly red)
  • Fevers
  • Pain in the lower back

Common diseases of the prostate include:

  • Prostatitis
  • Benign prostatic hypertrophy
  • Prostate Cancer

The prostatic urethra permits flow of urine out of the bladder.  If there is inflammation, tumor, or swelling of the prostate gland this may interfere with flow of urine out of the bladder.  Much of the symptoms of prostate disease is due to this.

Urinary retention is incomplete emptying of the bladder or inability to empty the bladder.  Nocturiais having to awaken at night to urinate.  Often this involves frequent trips to the bathroom and the actual amount of urine passed is small and due to incomplete emptying of the bladder.  Frequency is a similar symptom.  Straining and intermittency involve difficulty starting and maintaining the urinary stream, respectively.  Pain in the bladder region or lower back with fever can all be signs of infection in the prostate, bladder, kidneys or some combination of these.  Pain in the lower back can occur with prostate disease due to distention of the urinary tract, infection in the kidney and also from prostate cancer that spreads to bones of the back.  Seeing some blood in the urine may be a sign of prostate infection or prostate damage occurring with very hard straining to initiate the urine stream.

Having an enlarged prostate is frequent as men age and is not generally a sign or a precursor for prostate cancer.  Prostate cancer can occur with few symptoms and this is why screening and early detection is so important.  There are very effective treatments for most prostate cancers.

With enlargement of the prostate to the point it causes symptoms, often treatment is desired to improve the resulting problems such as urinary retention and nocturia.  The prostate gland’s size can sometimes be decreased a bit with medications that block the action of testosterone on it.  The gland can be relaxed (smooth muscle around and in the prostate) with medications that act as smooth muscle relaxants.  These may allow easier passage of urine.

Part of the prostate gland can be destroyed with a needle based therapy that delivers energy into the gland itself to “cook” it or destroy part of it.  The prostate gland can be removed entirely to treat severe enlargement and prostate cancer.

REFERENCES:

  1. www.cancer.gov/cancertopics/factsheet/Sites-Types/metastatic
  2. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18thed.  Chapter 77.  New York, NY: Saunders.
  3. Wein, AJ: (2007) Wein: Campbell-Walsh Urology, 9thed.  Chapter 2. Philadelphia, PA: Saunders Elsevier
  4. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.