Prostate Cancer Symptoms & Screening

Most men rarely think about their prostate gland. But they should. Prostate cancer is the second most common cancer in men. It impacts one in eight men, and your prostate cancer risk increases as you age.

If doctors detect prostate cancer early, it's easily treatable and five-year survival rates are near 100 percent. That's why it's important to know the signs of prostate cancer and talk to your doctor when you think something is wrong with your prostate.

Here's what you need to know about prostate cancer symptoms, risk factors and screening.

Key Takeaways: Prostate Cancer Symptoms, Screening and Risk Factors

• Prostate cancer risk quickly rises after age 50.
• Early-stage prostate cancer rarely causes symptoms, so routine prostate cancer screening is essential for early detection.
• Patients can work with their doctor to create a personalized treatment plan based on their screening results.

Where Is Your Prostate Gland?

Your prostate, a walnut-sized gland in the male reproductive system, sits below your bladder and wraps around your urethra, the tube that lets urine and semen leave your body. Your prostate produces fluid that nourishes and transports sperm. It also makes a protein called protein-specific antigen (PSA). Doctors measure your PSA level to detect early signs of prostate cancer.

What Are Symptoms Of Prostate Cancer?

In most cases, prostate cancer grows slowly.

Early prostate cancer symptoms

Early-stage prostate cancer usually produces few symptoms. Some men don't experience prostate cancer symptoms at all. But as prostate cancer advances, you can experience symptoms like:

• Back or hip pain
• Blood in urine or semen
• Erectile dysfunction
• Fatigue
• Frequent, difficult or painful urination
• Pelvic discomfort
• Weak urine flow
• Weight loss
• Being unable to completely empty your bladder, which may lead to dribbling of urine
• Feeling that you need to urinate frequently at night or when your bladder is empty

If you experience any of these symptoms, talk with your urologist. They can evaluate you and make an accurate diagnosis.

Later prostate cancer symptoms

When prostate cancer has spread to other parts of the body, symptoms can include:

• Bone pain
• Weakness or paralysis caused by compression of the spinal cord
• Weight loss
• Anemia
• Kidney failure

What Are Prostate Cancer Risk Factors?

Prostate cancer is rare in men under 40. Doctors diagnose roughly 60 percent of cases in men over 65. The American Cancer Society recommends men with average risk start prostate cancer screening at age 50, when the chances for developing the disease begin to increase rapidly. Men at higher risk should start screening at 40.

Any man can develop prostate cancer. But these factors increase your risk:

• Age: Prostate cancer risk begins to increase at age 50.
• Being Black: African American men and Caribbean men of African descent develop prostate cancer more often and at younger ages.
• Chemical exposures: Exposure to toxic chemicals, like arsenic, in the workplace can increase your risk.
• Diet: A diet high in red meat and full-fat dairy but low in fruits and vegetables may increase your prostate cancer risk. Foods rich in saturated fat may raise testosterone levels, which stimulate prostate growth.
• Family history: Prostate cancer can run in families. Having a father or brother with the disease more than doubles your risk. A man is 4.5 times more likely to get prostate cancer if his brother has it, and 2.3 times more likely to develop prostate cancer if his father has it. Your risk is even higher if several of your family members were diagnosed with prostate cancer.

What Is Prostate Cancer Screening?

“A prostate cancer screening is a screening evaluation for men, typically age 50 to 70 to screen for prostate cancer,” said Robert Korsch, DO, a urological surgeon at Franciscan Health Michigan City.

Prostate cancer screening is the key to early detection. In many cases, early-stage prostate cancer produces few symptoms. So, screening is important to identify the disease when it's most treatable. A prostate screening exam includes a physical test and a blood test, and this screening helps doctors identify the disease when it's most treatable.

Your doctor may use one of the following tests to screen for prostate cancer:

Digital rectal exam (DRE)

A digital rectal exam is a simple, potentially life-saving screening for men to check for prostate cancer. It's also something that most people would rather avoid. If your doctor recommends a digital rectal exam, try to put your squeamishness aside and look at the big picture. A few moments of discomfort could be the key to a healthy future.

The digital rectal exam, which can reveal prostate size and provide clues to a clearer diagnosis, is very straightforward: Your doctor will slide a gloved, well-lubricated finger into your rectum to feel for anything out of the ordinary, such as lumps or hardness that may indicate a hidden condition. It lasts less than a minute and usually doesn't cause any pain, although there might be some slight soreness after the test.

Your doctor can use the digital rectal exam to check your prostate gland for unusual swelling, lumps, or areas of hardness, all potential red flags for cancer. Many malignant tumors start in the outer part of the prostate and may be found with this exam. If your prostate is larger than normal, you may have benign prostatic hyperplasia, a very common, noncancerous condition that can make it difficult for you to urinate. If your prostate is tender when it's touched, the gland may be infected, a condition called prostatitis.

Prostate-specific antigen (PSA) test

Sometimes tumors on the prostate gland can lie just out of reach. According to the American Urological Association, most prostate cancers are detected with a prostate specific antigen (PSA) blood test.

A prostate-specific antigen (PSA) test is a blood test that checks for a substance, called prostate-specific antigen (PSA), which the prostate gland produces in your blood. Measuring PSA levels can help find cancer in the prostate while it is still microscopic. A PSA level above 4 raises the suspicion of prostate cancer.

Prostate-specific antigen is a protein produced by the prostate regardless of whether cancer is present. However, an elevated value should raise concerns and, thus, is used and studied extensively. It is crucial to take PSA measurements in context of age, size of the gland and other factors such as an enlarged prostate, prostatitis and certain medications a patient may take.

"If we identify cancer through either a digital rectal exam or a PSA blood test, we may recommend further testing before we choose an effective treatment plan," said Michael Eaton, MD, medical director for Franciscan Health Cancer Center in Indianapolis.

Prostate MRI

For some men with a family history or prostate cancer or a rising PSA level after a negative biopsy, a prostate MRI scan can be an effective monitoring tool. Doctors can use prostate MRI to keep track of a patient's cancer and make treatment decisions.

When Should I Start Prostate Cancer Screening?

According to the American Cancer Society, men with average risk should begin cancer screening at age 50. Men with a higher risk of prostate cancer should discuss prostate cancer screenings with their doctor at age 40. These groups include Black men and men with a close family history of disease.

What Do My PSA Test Results Mean?

In general, results below 4.0 ng/mL (nanograms per milliliter) are seen as normal.

“Generally speaking, for men aged 50 to 70, we want to see a PSA less than four,” Dr. Korsch said. “That usually indicates an overall lower risk of prostate cancer. And once that PSA starts getting up above four on more than one occasion, it just indicates that the risk of prostate cancer may be a little bit higher, and you should see a urologist to do some further testing.”

An elevated prostate-specific antigen level may indicate the presence of prostate cancer and may prompt additional testing or a biopsy to confirm whether cancer is present.

“It's key to understand that it is prostate-specific, but not cancer-specific,” Dr. Korsch said. “So just because it is elevated or determined to be abnormal, it does not mean that a man has prostate cancer, but it can sometimes give an indication that there may be a higher risk for prostate cancer to demand if the PSA is elevated.

“To also rule out the large proportion of men with a high PSA that do not have prostate cancer to spare them of a biopsy, we use a lot of these new genetic tests and biomarkers. With the increase in utilization of these new genetic tests, we are sparing about 20, 30% of men of an unnecessary biopsy. So we're limiting biopsies to just those men who we feel are going to be at highest risk.”

After other factors are eliminated, a prostate biopsy and prostate MRI may be scheduled to look for any concerning lesions, tumors, or growth within the prostate that looks suspicious for prostate cancer.

Does An Elevated PSA Test Always Mean Prostate Cancer?

“There are several other benign conditions of the prostate that can actually result in an elevated PSA,” Dr. Korsch said. “So not all PSA rises are due to prostate cancer.”

Other causes of an elevated PSA include:

• Prostatitis 
• Benign prostatic hyperplasia (BPH)
• Urinary tract infection or irritation
• Certain medications

“Think of it like as a marker of irritation,” Dr. Korsch said. “So when the prostate's irritated, whether it be from prostate cancer, whether it be from inflammation or just enlargement of the prostate, these are all medical conditions that can raise a man's PSA and only one of those is truly harmful being prostate cancer.”

How Is Prostate Cancer Diagnosed?

If the PSA or digital rectal exam are inconclusive or shows signs of prostate cancer, your doctor may recommend one or a combination of these tests:

• Biopsy. Your doctor removes a small tissue sample (biopsy) from your rectum. Lab technicians closely examine the sample for cancer cells.
• Magnetic resonance imaging (MRI). This type of imaging uses high-powered magnets to create detailed images of the inside of your body. Your doctor can use these images to locate cancer.
• Ultrasound. This imaging uses sound waves to create images of the inside of your body. Your doctor can review them to locate areas of possible cancer.

Fortunately, prostate cancer is highly treatable, said Sandeep Bhave, MD, an independent radiation oncologist who practices at Franciscan Health Indianapolis. Up to 90 percent of men diagnosed with prostate cancer can be cured with treatment.

"There are many different treatment options for patients, including surgery, radiation therapy, hormonal therapy or a combination," he said.

What Is Prostate Cancer Treatment?

Prostate cancer affects every man differently, so your treatment will be unique to you. Franciscan Health takes a team-based, hands-on approach to deliver personalized care. We bring together a multidisciplinary team of expert urologists, medical oncologists, radiation oncologists and pathologists to treat your cancer. Together, we consider several factors, including advanced imaging results and whether you have early-stage or advanced disease, to create the right care plan.

For men who have early-stage disease or a low risk of developing prostate cancer, active surveillance — a watchful waiting strategy — is a common choice, Dr. Bhave said.

"Half of these patients don't need treatment at all. We follow them with PSA tests and biopsies as needed," he said. "So, most men may be able to avoid or delay treatment for a long time. And if they need treatment, it's generally quite tolerable."

If you need prostate cancer treatment, Franciscan Health offers a full range of options. 

Ultimately, Dr. Bhave said, it's important to be proactive if you notice any signs that may point to a problem with your prostate. Talking to your doctor early can lead to better long-term outcomes.

"It's important to get screened," he said. "If we find prostate cancer and can identify the stage early, we can get patients on a good path to treatment."

Frequently Asked Questions: Prostate Cancer Screening

How common is prostate cancer?

Prostate cancer is the most common cancer in American men, except for skin cancers. 

When should I get prostate cancer screening?

The American Cancer Society recommends men make an informed decision with their healthcare provider about whether to be screened for prostate cancer. These discussions should take place at:

• Age 50 for men at average risk of prostate cancer and who are expected to live at least 10 more years
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans, Caribbean men of African ancestry and men who have a father or brother diagnosed with prostate cancer before age 65
• Age 40 for men at even higher risk for prostate cancer. This includes men with more than one first-degree relative (father or brother) who had prostate cancer at an early age.

What happens in a prostate cancer screening?

Men who decide to be screened for prostate cancer should be tested with the prostate-specific antigen (PSA) blood test. A digital rectal exam also may be done as part of screening.

What is PSA?

PSA, or prostate-specific antigen, is a protein produced by the prostate gland. A PSA level above 4 can point to an increased risk of prostate cancer.

“This is something that's only made by the prostate. So when we detect it in a blood test, we know it's only coming from the prostate," said Robert Korsch, DO, a urological surgeon at Franciscan Health Michigan City. "It's not coming from any other part of the body.”

Does a higher PSA level mean I have prostate cancer?

Finding higher levels of PSA does not always mean a man has cancer. Benign conditions, like an enlarged prostate, can raise PSA levels.

What does a healthy prostate feel like?

A healthy prostate feels like the tip of your nose. If it feels harder, like your cheekbone, that can be cause for concern.

How often does prostate cancer screening happen?

How often you are screened for prostate cancer depends on your PSA level, general health, preferences and values.