Prostate Cancer - symptoms and stages

Prostate cancer is one of the few cancers that doesn’t exhibit outward signs of its presence i.e. symptoms, until it is in a relatively advanced stage. This means that an early symptom of prostate cancer is actually an indication that the cancer may have already spread and is beyond curative treatment.

Cancers in general can be categorised into 4 stages depending on the degree to which they have grown and spread around the body. In short and with reference to prostate cancer:

• T1 stage - this is the earliest stage. The cancer is often not visible i.e. it doesn’t cause any enlargement of the prostate and there are no symptoms felt.

• T2 stage – the cancer is still in the early stages however by now it is large enough to be felt during a digital examination. Often the prostate cancer still doesn’t cause symptoms.

• T3 stage – here the cancer has started to spread into the surrounding tissues (localised metastases). It is only now that the first signs and symptoms of prostate cancer are felt.

• T4 stage – by this final stage it is very likely that the prostate cancer has spread to distant sites meaning that symptoms may be felt in the areas that have become affected.

Therefore, although we may think of bladder discomfort as an ‘early’ prostate cancer symptom, it is actually indicative of late stage 2 or early stage 3 cancer where the survival rate rapidly begins to decline. Thus if any of the following symptoms are present for more than a few days, they should be reported to the doctor, even if it is only to rule out the possibility of them being prostate cancer related.

Early Cancer of the Prostate – Signs and Symptoms

Nearly all of the early signs of prostate cancer are bladder related because of the position of the prostate gland. Imagine an egg (the prostate gland) with a drinking straw pushed through it (the urethra). Now imagine that the egg begins to swell so that it squeezes the straw and stops fluid flowing through it. This is what happens when prostate cancer advances; the urethra (the tube that urine passes through on its way out of the body) becomes constricted so that the following symptoms are felt:

• Frequent urination with nocturia (night time trips to the toilet)
• An inability to urinate even though the urge is there
• A weak flow even though the patient is straining to go
• Prolonged urination
• The feeling that there is more urine to pass even though there isn’t
• Mild incontinence caused by the bladder retaining a small amount of urine

Unfortunately the same set of symptoms can be caused by at least two other prostate complaints and so diagnosing prostate cancer is often delayed because it is masked by one of these other two conditions.

Benign Prostatic Hyperplasia (or hypertrophy) is an enlargement of the prostate gland that occurs in older men. The cause of BHP is not exactly known however it is thought to be related to decreasing male hormone levels. It is not uncommon for cases of early prostate cancer to be diagnosed by accident when BHP develops and causes the lower urinary tract symptoms mentioned above. BHP is a non cancerous condition that is no threat to life however it can still require surgery to relieve the pressure on the urethra.

Similarly a condition known as Prostatitis also exhibits the symptoms commonly associated with prostate cancer. Prostatitis is a chronic bacterial infection where bacteria from the urinary tract or the large intestine cause the prostate gland to become swollen and inflamed. The only real difference between the two sets of symptoms is that prosatitis, being due to an infection, also causes the patient to have a fever and recurring bladder infections.

Prostate cancer can be slowly growing in the body for years before any symptoms of it are noticed. Men over the age of 50 should be screened regularly and those believed to be at increased risk should have an annual check-up. Screening however is an expensive process and so anybody not in the high-risk category can be and often are overlooked.

Thus by the time advanced cancer of the prostate symptoms become apparent it is often too late to do anything except treat the symptoms i.e. discomfort and pain. The advanced symptoms will be looked at more closely in the next two articles.