There are usually no specific signs or symptoms of early prostate cancer, so a man may live for many years without ever knowing he has the disease. As the cancer grows, it may eventually cause the prostate to squeeze the urethra, and a man may experience symptoms (such as difficulty in urinating) that are similar to other common noncancerous conditions of the prostate. In later stages of the disease, the most common symptom is bone pain. If a man experiences any of the following symptoms, he should see a doctor:
- Weak or interrupted flow of urine
- Frequent urination (especially at night)
- Difficulty urinating or holding back urine
- Inability to urinate
- Pain or burning when urinating
- Blood in the urine or semen
- Nagging pain in the back, hips, or pelvis
Prostate screening may include an annual physical examination, a digital rectal examination (DRE), and a prostate-specific antigen (PSA) test.
The digital rectal examination (DRE) is an examination performed in a physician's office in which the doctor inserts a gloved, lubricated finger into the rectum in order to feel the prostate. The prostate-specific androgen (PSA) test is a blood test in which the blood is examined to look for PSA, a substance that often increases in a man who has prostate cancer or another prostate disease. If a man's PSA levels are high compared to others in his age group, there is a higher chance that he may have prostate cancer.
The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information.
The discussion about screening should take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).
After this discussion, those men who want to be screened should be tested with the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.
Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.
Because prostate cancer grows slowly, those men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.
Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient's health, values, and preferences. See more information on screening guidelines and early detection of prostate cancer.