Prostate Cancer: Symptoms, PSA Test and Enlarged Prostate

Many men over 50 get up two or three times a night to pass urine, and wait for a weak stream to start. Most of the time this is an enlarged prostate, a common and harmless part of ageing. But the same symptoms can also be a sign of prostate cancer, which is one of the commonest cancers in men. Knowing the difference, and when to get tested, helps you avoid both needless worry and dangerous delay.

What is the prostate?

The prostate is a walnut-sized gland below the bladder that surrounds the urine tube (urethra) and makes some of the fluid in semen. It tends to grow with age, which is why urinary problems become common after 50.

Prostate cancer symptoms

Early prostate cancer often causes no symptoms at all. When symptoms appear, they can include:

• A weak or interrupted urine stream, and difficulty starting
• Needing to pass urine often, especially at night
• A feeling that the bladder is not empty
• Blood in the urine or semen
• Painful ejaculation, or new erection problems
• Pain in the lower back, hips or pelvis that does not go away, which can happen when cancer has spread to bone
• Unexplained weight loss and tiredness in advanced disease

Enlarged prostate or cancer?

Benign prostatic hyperplasia (BPH), the non-cancerous enlargement, causes almost the same urinary symptoms, and it is far more common. You cannot tell the two apart from symptoms alone, and having BPH does not protect you from cancer. If you have urinary symptoms, a doctor can check your prostate and arrange the tests that tell them apart.

How is it diagnosed?

• PSA blood test: measures a protein made by the prostate. A raised PSA can mean cancer, but also enlargement, infection or irritation. Recent ejaculation, cycling and a urine infection can raise it, so the test is usually repeated.
• Digital rectal examination: the doctor feels the prostate for hard or uneven areas.
• MRI scan: shows suspicious areas and helps to decide whether a biopsy is needed.
• Biopsy: small tissue samples confirm cancer and its grade.

Who should consider testing?

A PSA test is not suitable for everyone, because it can find slow-growing cancers that would never cause harm. Doctors recommend a conversation about the pros and cons from around 50, or from 45 if you have a brother or father who had prostate cancer. Do not simply order it without talking to a doctor, and take any urinary symptoms to your doctor whatever your age.

Treatment

Many prostate cancers grow slowly. The right treatment depends on how aggressive the cancer is, your age and your health.

• Active surveillance: careful monitoring with regular tests for low-risk cancer, with treatment only if it changes
• Surgery: removal of the prostate
• Radiotherapy: external beam or internal radiation
• Hormone therapy: lowers male hormones that feed the cancer, used for advanced disease or with radiotherapy
• Chemotherapy and newer drugs for advanced cancer

Side effects can include urinary leakage and erection problems, which doctors can help with, so ask about them before you decide.

Medicines for an enlarged prostate (not cancer)

If tests show BPH, doctors commonly prescribe:

• Alpha-blockers such as tamsulosin, alfuzosin and silodosin, which relax the muscle at the bladder outlet and help urine flow. They can cause dizziness when standing, so get up slowly.
• 5-alpha-reductase inhibitors such as finasteride and dutasteride, which shrink the prostate slowly over months.

An important point: finasteride and dutasteride lower the PSA level by roughly half. Always tell your doctor if you take them, so a PSA result is not misread. These medicines treat enlargement and do not treat or prevent prostate cancer.

Healthy habits

• Keep a healthy weight and stay active
• Eat plenty of vegetables, fruit, daal and fish, and less red and processed meat
• Limit tea, cola and caffeine in the evening if night-time urination bothers you
• Do not smoke
• Drink enough fluid in the day, and less in the two hours before bed

When to see a doctor

• Difficulty passing urine, a weak stream or night-time waking to urinate that is new or getting worse
• Blood in the urine or semen
• Unexplained lower back, hip or pelvic pain
• Complete inability to pass urine, which is an emergency
• A family history of prostate cancer, to discuss screening early

Key takeaways

• Urinary symptoms in older men are usually caused by a benign enlarged prostate, but cancer can look the same.
• PSA, a rectal examination and an MRI help tell them apart, and the PSA decision should be made with a doctor.
• Many prostate cancers grow slowly, and treatment is matched to the risk.
• Finasteride and dutasteride lower PSA, so always tell your doctor.

Related medicines on Medimart

These medicines are commonly prescribed for an enlarged prostate. They treat urinary symptoms and are not a treatment for prostate cancer.

• Tamsulosin: relaxes the prostate and bladder outlet to ease urine flow
• Alfuzosin: an alpha-blocker for urinary symptoms
• Silodosin: another alpha-blocker
• Finasteride: shrinks an enlarged prostate over time
• Dutasteride and tamsulosin: a combination for enlarged prostate

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse enlarged prostate medicines and cancer care products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor. Please discuss urinary symptoms and PSA testing with your doctor.