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Symptoms of prostate cancer

The usual symptoms include difficulty in starting and stopping the urinary stream, increase in frequency of urination and pain during urination. These symptoms are commonly referred to as “irritative” or “storage” urinary symptoms.

As the disease progresses, the urinary stream may be diminished (urinary retention), or it may simply dribble out and some patients may experience a feeling of bladder fullness after urination.

These symptoms are commonly referred to as “voiding” or “obstructive” urinary symptoms.
I must state here that these irritative and obstructive symptoms by themselves do not confirm the presence of prostate cancer in any single individual.

These can occur in men with noncancerous (benign) enlargement of the prostate, which is the more common form of prostate enlargement and can also occur in prostate cancer. However, the occurrence of these symptoms should prompt an evaluation by the urologist to rule out cancer and provide appropriate treatment.

Obstruction to the flow of urine causes some urine to stay in the bladder and provide a good medium for bacteria to flourish. Thus, recurrent urinary tract infections may also point to prostate cancer.
Rare symptoms that may manifest occasionally when the cancer is advanced may include blood in the urine (hematuria), painful ejaculation, and impotence (inability to have an erection).

If the cancer has spread to other organs (metastasis), symptoms may include tiredness, general feeling of being unwell, and weight loss. Spread of the cancer to the bones can cause deep bone pain, particularly in the hips and back or even bone fractures from weakening of the bone.
Spinal cord compression may occur when the cancer spreads to bones of the spine. The weakened vertebrae can collapse on and compress the spinal cord.

Typical symptoms that might signal acute spinal cord compression include weakness in the legs and difficulty walking, increased difficulty urinating or moving the bowels, difficulty controlling the bladder or bowels, and decreased sensation, numbness, or tingling sensation in the groin or legs. These are often preceded by pain in the hip (usually one-sided) or back lasting a few days or weeks. This condition is a true emergency and requires immediate evaluation.

The gold standard of managing prostate cancer is to pick it early before it spreads to other organs. This means that screening must be done annually once you hit 40 years. The most common screening method is the use of prostate specific antigen (PSA).

Although the PSA test does not confirm prostate cancer, it predicts the risk of prostate cancer. Currently, most prostate cancers are discovered when a prostate biopsy is performed after a raised serum prostate specific antigen (PSA) blood test is detected

Prostate cancers may be suspected with an abnormal prostate exam detected by digital rectal exam (DRE). A digital rectal exam (“digital” refers to finger) is part of a thorough regular health examination.

During DRE, the examiner inserts a gloved and lubricated finger in the rectum to feel the prostate for abnormalities. The exam may reveal asymmetry, swelling, tenderness, nodules, or irregular areas in the prostate.

A suspicious prostate exam prompts the urologist to request for a prostate biopsy to confirm or rule out the presence of prostate cancer.

Elevated prostate cancer antigen 3 (PCA3) is a test that may help to discriminate between cancer-related versus nonspecific PSA elevations. Unlike PSA, PCA3 is not affected by enlargement of the prostate, or an inflammation of the prostate therefore used in conjunction with PSA helps to predict prostate cancer. Measuring PCA3 is done using a urine sample after a prostate massage.

There are various guidelines on screening for prostate cancer. In Ghana, it is recommended that men at the age of 40 should be offered a baseline serum PSA test and a prostate exam (DRE) to ascertain the risk of prostate cancer.

Subsequent screening and tests may be performed according to the findings on this initial evaluation and an individual's risk of getting the disease on the basis of other factors such as race, ethnicity, and family history of prostate cancer.

Yearly PSA is recommended thereafter even when the risk is minimal. There is no universally accepted age limit after which screening should be stopped.

Once diagnosed and depending on whether it has spread to other organs or not, various modalities of treatment are available. Broadly, the modalities include active surveillance, radical removal of the prostate, radiation therapy, hormonal and chemotherapy.

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