Symptoms and diagnosis of prostate cancer

Symptoms

Cancers that are found within the prostate gland only are known as early prostate cancer. Men with early prostate cancer are unlikely to have any symptoms at all. Prostate cancers usually only cause symptoms when they are large enough to disturb your bladder or press on the tube that drains urine. For that reason, the symptoms of prostate cancer, when they appear, are like the symptoms of an enlarged prostate .

The symptoms of prostate cancer include:

• Passing urine more often, especially at night
• Pain or difficulty when passing urine
• Trouble starting or stopping the flow of urine
• The feeling of not having emptied your bladder
• Frequent pain in your lower back, hips or upper thighs
• Trouble having or keeping an erection
• Blood in your urine or sperm (very rare)

If you have any of the above symptoms, get them checked out by your doctor. But remember that most enlarged prostate glands are not cancer and can be easily treated.

Diagnosis

First, visit your family doctor (GP) if you are worried about any symptoms. Your GP can examine you and do some blood tests. If your GP is still concerned about you, he or she can refer you to a hospital specialist called a urologist for more tests.

Tests for prostate cancer

The PSA test

This is a blood test to measure the PSA level in your blood. A small sample of blood is taken from your arm using a needle and syringe. PSA is a protein made by the prostate gland that can be found into your bloodstream. Sometimes a raised PSA level can be a sign of prostate cancer. But more often it is caused by something less serious like an inflamed prostate or an enlarged prostate that comes with ageing.

A single PSA test cannot show you if a prostate cancer is present or if it is slow or fast growing. At present, a normal result is anything up to 4ng/mL. The rate at which the PSA doubles is important too, so PSA levels should be compared regularly. For example, if your PSA was 2 last year and 4 this year, it may need to be checked out.

Digital Rectal Exam (DRE)

This involves your doctor putting a gloved finger into your back passage to feel your prostate. This test can find cancers that are in nearby tissues, but overall it can find less than half of prostate cancers. The test may be a little uncomfortable but is quick.

For more information on the symptoms and diagnosis of prostate cancer, please see our booklet Understanding the PSA test.

National Cancer Control Programme (NCCP)

In February 2010 the National Cancer Control Programme (NCCP) produced National Prostate Cancer Referral Guidelines for General Practitioners. These provide advice for GP´S about the referral process for men with suspected prostate cancer, including advice on where Rapid Access Prostate Cancer Centres are located and direct contact information for health care staff.

The NCCP is in the process of establishing rapid access clinics for the assessment of patients with suspected prostate cancer. These clinics will be located in each of the Cancer Centres. The rapid access clinics are currently open and operating in:

1. St. James’s Hospital
2. St Vincent’s University Hospital, Dublin
3. Mater Misericordiae University Hospital, Dublin - Urology Department
4. Mid Western Regional Hospital, Limerick
5. University Hospital Galway
6. Beaumont Hospital, Dublin
7. Letterkenny Hospital, Donegal

These clinics provide rapid access to a prostate clinic where they will be assessed by a Urologist and will have access to a Urology nurse.

The clinics have been established in an effort to speed up the process of referring men with a possible prostate cancer, to bypass waiting times for out-patient clinics and to provide access to prostate biopsy more quickly for those who need it.
It is anticipated that more clinics will become operational in early 2010, in Waterford Regional Hospital, Beaumont Hospital, Dublin , and Cork University Hospital.

Tests at the hospital

Transrectal ultrasound scan (TRUS)

This scan uses sound waves to build up a picture of the tissues inside your body. To scan the prostate gland, a small device called a probe is passed into your back passage and an image of the prostate appears on a computer screen. This type of scan is used to measure the size of the prostate. The scan may be uncomfortable but only takes a few minutes.

Transrectal needle biopsy of the prostate

The best way to diagnose prostate cancer is by taking samples of the tissues . It is usually done at the same time as an ultrasound. This involves putting a plastic probe into your back passage and passing a needle through the wall of your back passage to take samples (usually 6–12) from the prostate. Your doctors will then use a microscope to look for any cancer cells in the sample.

Further tests

If the tests show that you have prostate cancer, you may need other tests. This is called staging and can help your doctor to decide on the right treatment for you. Possible tests are:

• Bone scan
• X-rays
• CT scan
• MRI scan

Learn more about these further tests

Call our National Cancer Helpline

Freephone 1800 200 700 to talk to a specialist cancer nurse
It's open Monday-Thursday from 9am to 7pm and Friday from 9am to 5pm