Prostate Cancer – Early Detection

You can't sense that you have prostate cancer.

Particularly in the early stages prostate cancer rarely causes any typical symptoms. Unlike benign prostate hyperplasia, early prostate cancer mostly does not cause difficulties with urination for example.
Only very large tumors pressing on the rectum, as well as metastases in other parts of the body, cause pain. Symptoms, such as weight loss, night sweats, and anemia generally occur only in advanced stages. Detecting prostate cancer on your own is therefore almost impossible.

Early detection
Depending on the country and the individual risk situation of a patient it is recommended to start early detection around 45 years of age. During the examination, the physician feels the genitals and related lymph nodes in the groin, as well as the prostate itself from within the rectum. The disadvantage of this examination is that the physician can feel only relatively large prostate tumors. Smaller carcinomas that could be more readily treated generally remain undetected.
In case of any suspicious findings the treating physician requests further examinations, such as a transrectal ultrasound and the determination of the PSA-level. If there is a clear suspicion for prostate cancer a prostate biopsy to confirm the diagnosis has to be performed (see also Prostate Cancer – Diagnostics)

The role of PSA in early detection
The “PSA-Screening”, using the prostate specific antigen (PSA) as a biomarker, is still a controversial topic. Data from the US indicates that the PSA screening approach is helpful to detect prostate cancer at earlier stages. However, using a population based screening approach is on the other hand associated with a high risk of over-diagnosis and overtreatment. According to two large US and European Screening trials, PSA-screening for prostate cancer is not generally recommended1,2.

What you should also know
An enlarged prostate is usually the result of benign, age-related growth. An unpleasant symptom is a frequent urge to urinate, since an enlarged prostate exerts pressure on the urethra. Under some circumstances, bladder infections can occur if the bladder cannot be fully emptied. Even though these symptoms may be annoying, they are more frequently related to benign diseases of the prostate than to prostate cancer.

1Schroder FH, Hugosson J, Roobol MJ et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360: 1320-1328.

2Gerald L. Andriole, M.D. et al, Mortality Results from a Randomized Prostate-Cancer Screening Trial, N ENGL J MED 2009 360;1310-9.