What are the symptoms of prostate cancer?

Screening with the prostate-specific antigen (PSA) test can detect early-stage prostate cancer while it’s still asymptomatic. But some men are diagnosed with prostate cancer only after symptoms appear. For insights into how doctors distinguish prostate cancer from other noncancerous problems affecting the prostate, we spoke with Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Med

What are the first symptoms a man might notice if he has early-stage prostate cancer? I first want to mention that most men who are diagnosed with prostate cancer — including many with advanced forms of the disease — do not present with symptoms. When symptoms do appear in a man with early-stage disease, they affect his ability to urinate. Lower urinary tract symptoms (LUTS), as we call them, include urinary frequency, urgency, difficulty starting or stopping a stream, getting up repeatedly at night to pee, or feeling like you’re never able to fully empty your bladder. LUTS can develop if a tumor grows large enough to physically obstruct the urethra, which is the tube that carries urine out of the body. The diseased prostate can also push up against the bladder, thereby lessening its capacity to hold fluid. But more often than not, urinary symptoms result from other problems with the prostate. Benign prostatic hyperplasia (BPH), for instance, is a natural enlargement of the prostate that affects most men as they get older. Some men develop LUTS if the prostate and surrounding tissues become inflamed; this is called prostatitis. And if a man experiences burning sensations while urinating, then he likely has a problem with his bladder, not his prostate. Men who experience any of these urinary symptoms should be evaluated by a doctor. How would a doctor begin to narrow down the diagnosis? Assuming prostatitis and bladder disease have been ruled out, the next step is to differentiate between prostate cancer and BPH. Men with BPH typically have two kinds of urinary symptoms.

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