How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- having blood in your urine or semen
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
- stomach pain
How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
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Side Effects From Radiation
Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. âItâs more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,â Calvaresi said. These problems often go away once treatment is complete.
Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.
Men undergoing radiation are likely to have ED, but not immediately. âIt slowly sets in after radiation treatment,â Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.
Genitourinary Toxicity With Intensity
Intensity-modulated radiotherapy has been shown to deliver higher doses to the target area while minimizing complications. IMRT is increasingly used for the treatment of prostate cancer doses of 81 Gy have been delivered. The complication rate with IMRT is lower than that with 3-dimensional conformal beam therapy, although not all studies show a significant difference.
The frequency of toxicity with IMRT versus the frequency with 3D conformal radiotherapy is as follows.
- Grade 2: IMRT, 17-36% 3D conformal radiotherapy, 42-60%
- Grade 3: IMRT, 0.3-0.5% 3D conformal radiotherapy, 1-2%
After treatment for prostate cancer, rectal complications are much lower with conformal beam therapy than with 4-box, small-field therapy however, the incidence of bladder complications is unchanged, probably because of the proximity of the bladder neck and unavoidable exposure to the urethra.
IMRT has also demonstrated a significant improvement in rectal complications compared with 3D conformal radiation therapy. Fewer grade 2 bladder complications occur with IMRT, but the rates of grade 3 complications are similar. GI symptoms can be further reduced by using fiducial markerbased position verification in patients with prostate cancer.
A multicenter, phase II study conducted by Kim et al found that in patients with rectal cancer, preoperative chemoradiation with cetuximab, irinotecan, and capecitabine was active and well tolerated.
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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.
Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.
Scheduling Appointments For Blood In Urine Treatment At New York Urology Specialists
We offer affordable appointment prices with or without insurance. Same-day virtual video appointments and in-person appointments are available.
Dr. Shteynshlyuger MD is a board-certified urologist in NYC who specializes in treating urinary problems in men and women. He has performed hundreds of bladder, kidney, vaginal, and prostate surgeries.
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Further Treatments To Control The Cancer
Your first treatment may help keep your cancer under control. But over time, the cancer may change and start to grow again. If this happens you might be offered other treatments, including:
- more hormone therapy
- clinical trials
More hormone therapy
If youve had hormone therapy on its own as a first treatment, you might be offered a chemotherapy drug called docetaxel . This may help some men to live longer, and can help to improve and delay symptoms. If youve already had docetaxel, you might be offered more docetaxel or another chemotherapy drug called cabazitaxel .
This is a type of internal radiotherapy that may be an option if your cancer has spread to your bones and is causing pain. A radioactive liquid is injected into your arm and collects in bones that have been damaged by the cancer. It kills cancer cells in the bones and helps some men to live longer. It can also help to reduce bone pain and delay some symptoms, such as bone fractures. Read more about radiotherapy for advanced prostate cancer.
The Initial Causes Blood In Urine Prostate Cancer
One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.
Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.
If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.
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What Is The Outlook
No cure is available for stage 4 prostate cancer. Your healthcare team will work with you to help control the cancer for as long as possible while maintaining a good quality of life.
Your outlook will depend on how fast the cancer is spreading and how well you respond to therapies.
With treatment, you can live for many years with metastatic prostate cancer.
Signs And Symptoms Of Prostate Cancer
Most prostate cancers are found early, through screening. Early prostate cancer usually causes no symptoms. More advanced prostate cancers can sometimes cause symptoms, such as:
- Problems urinating, including a slow or weak urinary stream or the need to urinate more often, especially at night
- Blood in the urine or semen
- Trouble getting an erection
- Pain in the hips, back , chest , or other areas from cancer that has spread to bones
- Weakness or numbness in the legs or feet, or even loss of bladder or bowel control from cancer pressing on the spinal cord
Most of these problems are more likely to be caused by something other than prostate cancer. For example, trouble urinating is much more often caused by benign prostatic hyperplasia , a non-cancerous growth of the prostate. Still, its important to tell your health care provider if you have any of these symptoms so that the cause can be found and treated, if needed. Some men might need more tests to check for prostate cancer.
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Expert Review And References
- American Cancer Society. Prostate Cancer Early Detection, Diagnosis, and Staging. 2019: .
- Garnick MB . Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
- Hermanns T, Kuk C, Zlotta AR. Clinical presentation, diagnosis and staging. Nargund VH, Raghavan D, Sandler HM . Urological Oncology. Springer 2015: 40: 697-718.
- Logothetis CJ, Kim J, Davis J, Kuban D, Mathew P, Aparicio A. Neoplasms of the prostate. Hong WK, Bast RC Jr, Hait WN, et al . Holland Frei Cancer Medicine. 8th ed. People’s Medical Publishing House 2010: 94: 1228-1254.
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
Eating Problems And Weight Loss
Some men with advanced prostate cancer have problems eating, or dont feel very hungry. You might feel or be sick. These problems may be caused by your cancer or by your treatments. Being worried about things can also affect your appetite.
Problems eating or loss of appetite can lead to weight loss and can make you feel very tired and weak. Advanced prostate cancer can also cause weight loss by changing the way your body uses energy.
What can help?
If you feel sick because of your treatment, your doctor can give you anti-sickness drugs. Steroids can also increase your appetite and are sometimes given along with other treatments.
Try to eat small amounts often. If youre struggling to eat because of nausea , try to avoid strong smelling foods. Cold foods tend to smell less, or it may help if someone cooks for you. Try to eat when you feel less sick, even if its not your usual mealtime. Fatty and fried foods can make sickness worse. Drink plenty of water, but drink slowly and try not to drink too much before you eat.
Tell your doctor if you lose weight. They can refer you to a dietitian who can provide advice about high calorie foods and any supplements that might help. It can be upsetting for your family to see you losing weight, and they may also need support. Macmillan Cancer Support and provide support and information about eating problems in advanced cancer.
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Blood That You Cant See
Sometimes there is blood in your urine that you canÃ¢t see. This is called microscopic hematuria because it is only visible under a microscope. Ã¢Guidelines state that any more than three red blood cells in a urine sample under microscope should prompt a referral to a urologist,Ã¢ Dr. Bakare says. Routine urine tests can be part of annual wellness exams.
What Are The Symptoms Of Prostate Problems
The symptoms of prostate problems may include
- urinary retentionthe inability to empty the bladder completely
- urinary frequencyurination eight or more times a day
- urinary urgencythe inability to delay urination
- urinary incontinencethe accidental loss of urine
- nocturiafrequent urination at night
- trouble beginning a urine stream
- weak or interrupted urine stream
- blockage of urine
- urine that has an unusual color or odor
- pain after ejaculation or during urination
Different prostate problems may have similar symptoms. For example, one man with prostatitis and another with BPH may both experience urinary urgency. Sometimes symptoms for the same prostate problem differ among individuals. For example, one man with BPH may have trouble beginning a urine stream, while another may experience nocturia. A man in the early stages of prostate cancer may have no symptoms at all. Because of this confusing array of symptoms, a thorough medical exam and testing are vital.
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Medication For Urinary Problems
Your doctor may suggest various medications to help ease your urinary problems, including:
- medications to reduce the tone of the muscles of the urethra and prostate to minimise any constriction to urine flow caused when these muscles contract
- medication to reduce the size of the prostate gland. These medications work by blocking the action of male hormones produced by the prostate gland
- medications to relax the bladder, making unwanted contractions less likely and reducing the symptoms of urgency and frequency of urination
- the over-the-counter preparation Ã¢saw palmettoÃ¢ is sometimes used. This may help some men, especially if frequent urination at night is a problem.
However, recent reviews of the evidence for using saw palmetto as a treatment for mild or moderate urinary symptoms did not show any improvement, compared to no treatment, in men with BPH.
Problems After Prostate Cancer Treatment
Many men get urinary problems as a side effect of their treatment. This is because prostate cancer treatment can damage the nerves and muscles that control when you urinate .
If youre starting treatment for prostate cancer, ask your doctor about the possible side effects. Each treatment can cause different urinary problems. Your chances of getting each side effect will depend on the treatment youre having, and on whether or not you had urinary problems before starting treatment.
If youve already had prostate cancer treatment and you have urinary problems, tell your doctor or nurse. They can suggest treatments and lifestyle changes to help manage them.
Depending on the type of problems youre having, ways to manage them can include lifestyle changes, pelvic floor muscle exercises, bladder retraining, medicines or surgery. For practical tips read our How to manage urinary problems guide.
Watch Paulâs story below for one manâs experience of managing urinary problems after prostate cancer treatment.
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Transurethral Electro Resection Of The Prostate
Removing the enlarged part of the prostate is usually the best long-term treatment for an enlarged prostate gland. The portion of the gland that is not squeezing the urethra stays in place. The outside capsule around the gland is also untouched.
Transurethral electro-resection of the prostate is the traditional way to remove prostate tissue using minimally invasive surgical techniques. No outside incision is needed. ThereÃ¢s less pain, fewer complications and faster healing.
Prostate Cancer Screening Tests
Prostate cancer screening tests are preventive health screenings you can get through your doctor or at community screenings. These medical screenings are important because early detection by way of preventive screening of cancer can significantly increase your chances of survival. Additionally, prostate cancer does not always have early warning signs, making the screenings even more important.
The PSA Test checks the amount of prostate-specific antigen in your blood. It also appears in semen. The PSA test can detect whether the amount of the protein is high but other things such as enlarged prostate, without cancer, can also lead to a high PSA. This means that physical exam and possibly biopsy must be done before a diagnosis can be made. It is important to talk to your doctor about your PSA test in relation to your risk factors and overall health.
Roughly one of out nine men will be diagnosed with prostate cancer at some point during their lifetime. If you notice any of these signs and symptoms listed above, or even if you dont, its time to think about prostate cancer screening tests. Talk to your doctor about your risk.
What Happens After The Prostate Tests
Urodynamic tests and cystoscopy may cause mild discomfort for a few hours after the procedures. Drinking an 8-ounce glass of water every half-hour for 2 hours may help reduce discomfort. The health care provider may recommend taking a warm bath or holding a warm, damp washcloth over the urethral opening to relieve discomfort. A prostate biopsy may produce pain in the area of the rectum and the perineum, which is between the rectum and the scrotum. A prostate biopsy may also produce blood in urine and semen.
An antibiotic may be prescribed for 1 or 2 days to prevent infection.
Patients with signs of infectionincluding pain, chills, or fevershould call their health care provider immediately.