Prostate cancer: symptoms, PSA testing and treatment options review

Prostate cancer usually happens in men over 50, and it often grows slowly. Because early disease often causes no symptoms, people often ask about testing, and whether treatment is always needed. This article explains the main facts using information from the NHS and the US National Cancer Institute.

1. Introduction

The prostate is a gland under the bladder. Prostate cancer affects this gland and usually happens in men over 50 ^[1]. The NHS notes that anyone with a prostate can get prostate cancer, and it lists some factors that raise the chance ^[3].

An important point is that prostate cancer often grows slowly and may never cause problems ^[5]. The NHS also says prostate cancer does not always need treatment, so decisions are made with each person and their care team ^[5].

2. Causes and risk factors

The NHS lists these main risk factors ^[3]:

• Age. Risk rises as you get older, and most cases occur in people over 50.
• Ethnic background. Men of Black African or African Caribbean background have a higher chance of developing prostate cancer.
• Family history. Having a close relative with prostate cancer raises the risk.
• Inherited genes. A close relative with pancreatic, breast or ovarian cancer, especially at a young age, may point to shared inherited genes. A faulty BRCA2 gene is one example.

3. Signs and symptoms

Prostate cancer often causes no symptoms early on. When changes do occur they are usually urinary ones ^[2]:

• Difficulty starting to pass urine, or straining
• A weak flow
• A flow that stops and starts
• Needing to go urgently or often
• Feeling you still need to go just after finishing
• Waking at night to pass urine

Other possible signs are erectile dysfunction (difficulty getting or keeping an erection) and blood in the urine or semen. In advanced cancer there may be lower back pain or unintended weight loss ^[2].

These symptoms do not always mean cancer. An enlarged prostate is common, is not cancer, and can cause the same problems ^[2]. A doctor can check which cause is behind the symptoms.

4. Diagnosis and tests

The PSA blood test. Prostate-specific antigen (PSA) is a protein made by normal and cancerous prostate cells, and a blood test measures its level. Doctors use it to follow up urinary or prostate symptoms, to monitor known prostate cancer, and sometimes to screen men without symptoms ^[6]. The National Cancer Institute explains that a high level does not confirm cancer, because an enlarged prostate and prostatitis (inflammation of the prostate) can also raise it. Infection, a recent biopsy, vigorous exercise and ejaculation can raise it for a short time ^[6]. If someone with no symptoms has a high result, the doctor may suggest repeating the test a few weeks later. If the level keeps rising, the doctor may recommend further tests such as an MRI scan or a biopsy ^[6]. The NHS says that if your PSA result is higher than normal you will be offered other tests to see if you have prostate cancer or something less serious, such as an enlarged prostate or an infection of the prostate ^[2].

Scans and biopsy. If you are referred to a specialist, you will usually have an MRI scan to get a clearer view of the prostate and decide whether more tests are needed. A biopsy, in which a needle takes small samples of prostate tissue to check for cancer cells, may follow ^[4]. Results can take a few weeks, and the NHS advises calling the hospital or your doctor if you have not heard back after two weeks or your symptoms get worse ^[4].

If cancer is found, you may need further scans, such as CT, MRI, PET or a bone scan, to help the team plan treatment ^[4].

Benefits and harms of PSA screening. Screening may find cancer earlier, and studies show a small reduction in deaths from prostate cancer. The harms include overdiagnosis (finding cancers that would never have caused problems), unneeded treatment with urinary, bowel and sexual side effects, false alarms and biopsies that can cause infection, pain and bleeding ^[6]. The National Cancer Institute says the PSA test is not recommended for routine screening of the general population, and that most organisations advise people who are thinking about PSA screening to discuss the risks and benefits with their doctor first ^[6].

5. Treatment and management

Your specialist team will explain the options that suit your cancer and your health. The NHS describes these ^[5]:

• Active surveillance. Used when the cancer is small and not causing symptoms. It involves regular tests and scans in hospital. If the cancer grows or causes symptoms, treatment options are discussed. A related approach, watchful waiting, uses check-ups and blood tests with your doctor instead.
• Surgery (radical prostatectomy). Removes the prostate gland. Possible side effects include urine leakage, erectile dysfunction and changes to orgasm.
• Radiotherapy. Uses high-energy radiation to kill cancer cells. It can treat cancer that has not spread far or advanced cancer, and can ease symptoms.
• Hormone therapy. Testosterone fuels prostate cancer growth, so injections or tablets either stop the body making it or block its effects. It can be used at any stage, alone or with other treatments, and on its own it can slow the cancer and relieve symptoms.
• Other options. Chemotherapy is used when cancer has spread beyond the prostate. Treatments using sound waves or freezing are sometimes used for cancer that has not spread, but may not be available everywhere.

The NHS notes that treatments can cause side effects that are sometimes serious and long-lasting, so ask your care team about each option, including how it may affect fertility ^[5].

6. Prevention and self-care

The sources reviewed here do not describe a proven way to prevent prostate cancer. The most practical steps are to understand your own risk, and to talk to your doctor if you are worried ^[3]. If you have been diagnosed, ask your team about support, as a clinical nurse specialist is usually your main contact ^[4].

7. When to see a doctor

The NHS advises seeing a doctor if you have trouble passing urine or any of the symptoms above, if you are over 40 and genetic testing has found a faulty BRCA2 gene, or if you are worried about your risk of prostate cancer. You can ask about a PSA test even without symptoms. The doctor will consider your cancer risk to help decide if the test is right for you, and the NHS says PSA tests are not routinely offered if you have no symptoms ^[2]. See a doctor again if your symptoms change, get worse or feel unusual, even if you have got used to them ^[2].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Prostate cancer usually affects men over 50, often grows slowly and often causes no symptoms early on. The PSA test can raise a warning but cannot confirm cancer, and testing has both benefits and harms. Active surveillance, surgery, radiotherapy and hormone therapy are the main choices, and each has different side effects. Talk with a doctor about your own risk, your wishes and the possible benefits and harms before testing or treatment.