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3: The Signs & Symptoms
THE SIGNS & SYMPTOMS 3
One of the most common phrases I hear when I tell men they have prostate cancer is “But, I have no symptoms”. If you have just been diagnosed with this disease, you may be asking yourself the same thing – there were no warning signs or symptoms, so how can this be true? Unfortunately, early prostate cancer does not often cause any problems, which is why it is called a ‘Silent Killer’. Most prostate cancers start on the outer part of the prostate, which means it must grow quite large before it causes any problems. As men age, the central part of the prostate, which surrounds the urethra grows. This is called benign prostatic enlargement or hyperplasia (BPH). As it grows, it narrows the urethra, and this is what gives the common symptoms as men get older. This growth is usually benign but can rarely be due to cancer. BPH does not turn into cancer.
Normal prostate Enlarged Prostate
Some common symptoms of BPH and occasionally due to cancer include the following:
• Frequent visits to the toilet (frequency) • Getting up frequently at night (nocturia) • Difficulty starting to pass urine (hesitancy) • Decreased force/ weak urinary stream or one that is thin or dribbling • Urinary stream is not continuous and instead stop and start (intermittency) • Having to strain to pass urine • Sense of not completely emptying your bladder • Need to rush when passing urine (urgency) • Starting to leak urine before making it to the toilet (urge incontinence) • Difficulty in having an erection or ejaculating • Blood in the urine or semen • Not passing urine altogether (retention)
Other symptoms of prostate cancer can be because of the cancer advancing Common Questions to nearby areas or spreading further afield, potentially resulting in some of the following symptoms:
1. Can I live without my prostate? Yes, a man can live without his prostate. • Pain in the back, hips, or pelvis – often because of spread to the bones • Unexplained weight loss The whole prostate may be removed for cancer or part of it when it is enlarged and • Feeling tired causing symptoms. • Kidney failure 2. What conditions other than cancer can affect the prostate? • Benign (non-cancerous) enlargement called BPH • Prostatitis - infection or inflammation of the prostate. 3. Do biological women have a prostate? No. 4. How big can the prostate get? There is no real upper limit. • A small sized prostate has a volume of 30-40ml • A medium sized prostate has a volume of 40-80ml • A large sized prostate has a volume greater than 80ml.
Common Questions
If I have no symptoms, how will I know if I have prostate cancer?
Check to see if you are at a higher chance of getting cancer by looking at your risk factors. If you are worried, speak to your doctor about having a prostate examination and a PSA blood test, which is discussed in more detail in the next chapter
Why does prostate cancer not usually cause symptoms?
The prostate has different regions or zones. The following zones make up the prostate, starting from outside to the inside: • Peripheral zone – this is the back of the gland near the back passage (rectum) and most prostate cancers occur in this area (70-80% of all cancers). As this is furthest away from the inside, the cancer needs to grow quite large before it causes symptoms. This is the area that a doctor feels when they examine the prostate with a finger • Central Zone – this surrounds the ejaculatory ducts and only approximately 5% of cancers start here • Transition zone – this surrounds the urethra and grows throughout life.
BPH occurs in this area. As this develops, it can narrow the urethra, thereby causing the classical symptoms of ageing men. However, only about 20% of cancers occur here, which explains why symptoms are more common with benign enlargement than with cancer
If I have a large prostate, should I have symptoms?
A larger prostate does not mean you will have bothersome symptoms. Some men with huge prostates have few, if any, symptoms
Can I have BPH and prostate cancer at the same time?
Yes, it is possible for a man to have an enlarged prostate due to benign enlargement as well as cancer
