Symptoms: Recognizing the Signs of Prostate Cancer

If the male reproductive organs were a band, the prostate gland is the bass player: steady, reliable and integral to creating the backbone of songs—yet underappreciated.

Truth be told, nobody thinks about them much.

However, if the prostate is out of tune, you notice right away. This bass player keeps the beat and drives the van.

The prostate is a walnut-sized muscular gland responsible for making prostatic fluid, which mixes with sperm when a man ejaculates. It's also in charge of creating the pulses felt during climax. That's when the prostate's smooth muscle fibers contract and force seminal fluid through ducts into the urethra to mix with sperm and exit the penis.

Due to its location, just below the bladder and surrounding the urethra, when the prostate gland is unhealthy, it often presents with symptoms linked to urination and ejaculation.

The past half-century has seen some incredible advances in how healthcare providers approach screening, diagnosis and treatment for prostate cancer. It's the second-most common type of cancer in men, behind only skin cancer. Indeed, from a particular perspective, you could say prostate cancer is almost inevitable with a long enough runway.

"There's a common saying that if you live long enough, most men are going to get prostate cancer," said Jayram Krishnan, D.O., a urologic oncology specialist with the Cleveland Clinic. "We know there's some degeneration that happens in your prostate that causes prostate cancer. That's why screening stops at 70 in patients with no other risk factors."

However, for men younger than 70, particularly those in their 40s and 50s, aggressive outreach and education, technological innovations and constant updating of guidelines when new research becomes available have greatly contributed to a drastic reduction in prostate cancer cases.

New diagnoses of prostate cancer have been trending steadily downward for two decades, according to the Centers for Disease Control and Prevention. In 1999, the national rate was 169.4 per 100,000 men, whereas in 2018, the rate was 108 per 100,000. Some states, even those with wide-ranging diversity in age such as Colorado and California, have managed to reduce the number to less than 100 per 100,000.

Still, prostate cancer continues to affect nearly 250,000 men annually in the United States alone, killing more than 34,000 per year. The disease remains frustratingly difficult to predict—absent screening—for a number of reasons.

Prostate cancer has been known over the years as "the hidden killer" or "the silent killer." For starters, the disease, on the whole, is notoriously slow to develop, apart from a tiny minority of fast-growing types. About 95 percent of prostate cancers take years or even a decade to develop.

This slow rollout informs every aspect of how the condition is approached, including how we look at screening and, importantly, how we talk about the symptoms.

You may not experience symptoms until the tumor or tumors have been developing for a very long time. And even if you do get symptoms, they may not be immediately recognizable as prostate cancer symptoms, because a number of other conditions can cause similar changes in your body.

"There are no symptoms specific to just prostate cancer—it's usually the common symptoms with an enlarged prostate," said Neel Parekh, M.D., a urologist with the Cleveland Clinic.

For example, take a look at some of the urinary symptoms of prostate cancer:

• Frequent need to urinate, especially at night
• Trouble starting your stream or stopping it
• Weak or interrupted urine flow
• Burning or pain during urination
• Blood in the urine (hematuria)

This partial list is nearly identical to symptoms of benign prostatic hyperplasia (BPH) or enlarged prostate; the same can be said for many symptoms of prostatitis.

The prostate surrounds the urethra where it connects with the bladder, so any swelling, irritation, enlargement or tumor growth of the sort you get with any of these prostate conditions can cause the prostate to pinch and impede the urethra. These changes in the prostate then affect the flow of urine from the bladder out to the penis.

"The prostate enlarges [with prostate cancer], so you get more urinary symptoms," Parekh said.

In any case, regularly experiencing any of the above urinary symptoms should prompt a visit to your doctor for further testing.

Of course, the prostate's entire special purpose is to drive the engine of ejaculation in men. So it's no surprise that prostate cancer symptoms turn up in connection with bedroom activities.

Some other ways prostate cancer can present include erectile dysfunction (ED), painful ejaculation and blood in the semen.

As with the previous list of urinary-related symptoms, it's important to note that many of these sexual side effects can be caused by other conditions, as well.

On the other hand, the absence of symptoms doesn't guarantee you're in the clear. Along with its notoriously slow growth, prostate cancer is infamous for showing few, if any, effects even as it is steadily infiltrating healthy tissue in the gland.

"Most of the time, [prostate cancer] does not cause any symptoms," said Richard Heppe, M.D., whose practice is affiliated with the Urology Center of Colorado in Denver. "So a lot of people think, 'Well, I don't have any pain, so there must not be anything wrong.' That's not necessarily true."

The big problem with discussing prostate cancer symptoms is that you have to acknowledge a scary truth: If you experience symptoms of prostate cancer, it's likely to be pretty advanced already.

"Prostate cancer, most of the time, is asymptomatic," Heppe said. "Most of the time, you don't have any symptoms until it's very progressed."

"Progressed" in this context means cancer has been developing for a while and may have spread to other parts of the body, such as the pelvis, the lymph nodes or the stomach. This can cause several possible symptoms:

• Swelling in the legs or pelvis
• Numbness or swelling in the feet, legs or hips
• Persistent bone pain and possible fractures
• Loss of bowel control or stomach pain
• Constipation
• Blood in your stool
• Fatigue
• Nausea or vomiting

"Some of the later signs could be blood in the urine, bone pain, back pain—that's one of the places that prostate cancer can spread to, is the bones," Parekh said.

Keep in mind that even in the later stages of prostate cancer, all is not necessarily lost. Successful treatment is more complicated at that point, but it is still possible even in later stages.

The difficulty in ferreting out symptoms early on in the development of prostate cancer can be looked at in a number of different ways.

We can see it as frustrating that there aren't many symptoms unique to prostate cancer to give us a clear-cut early warning.

Or we can use that fact to motivate ourselves to get regular screenings according to our age and other risk factors.

Prostate cancer treatments have come incredibly far in recent years, as we'll see in forthcoming installments of this series. As with all cancer, though, the key to getting the help you need to beat it is getting at it early.

Consult the guidelines for prostate cancer screening and speak to your doctor about your risk factors and setting up a regular screening schedule if you're a candidate.

Just make sure you've got all the information you and your medical team need to keep you healthy.