One of the most common things men say after a prostate cancer diagnosis is that they felt perfectly well. That is not unusual. In its early stages, prostate cancer very often causes no symptoms at all, which is why understanding your risk matters as much as watching for warning signs.
Why early prostate cancer is often silent
Most prostate cancers start in the outer part of the gland, known as the peripheral zone. This area is some distance from the urethra, the tube that carries urine through the prostate. A small cancer here does not press on the urethra, so it does not change how a man passes urine.
Early prostate cancer also tends to grow slowly. It may be present for years before it becomes large enough, or spreads far enough, to cause any problem a man would notice.
Urinary symptoms and what they usually mean
Changes in passing urine are a common reason men visit their GP. These include:
- passing urine more often, especially at night
- a weak flow or needing to strain
- a sudden urge to go
- dribbling at the end
- feeling that the bladder is not empty
These symptoms are most often caused by benign prostatic enlargement, a non-cancerous growth of the prostate that is very common with age. They are still worth reporting. A GP can check for other causes, and some men with an enlarged prostate also have a separate prostate cancer that is found during assessment.
Symptoms that may point to more advanced disease
When prostate cancer does cause symptoms, it is often because it has grown beyond the prostate or spread elsewhere. Signs that need prompt medical advice include:
- blood in the urine or semen
- new pain in the back, hips or pelvis that does not settle
- unexplained weight loss
- problems getting or keeping an erection that are new and unexplained
None of these means you definitely have cancer, but each deserves a proper assessment. The NHS prostate cancer guide lists the main symptoms and when to see a doctor.
Why risk matters more than symptoms
Because early disease is usually silent, the best way to find it at a curable stage is to know your risk and discuss testing with your GP. The main risk factors are:
- Age: risk rises steadily from the age of 50.
- Ethnicity: Black men have a higher risk than other men.
- Family history: a father or brother with prostate cancer increases risk, as does a strong family history of breast or ovarian cancer.
- Inherited gene changes: such as BRCA2.
Our article on smart BRCA gene screening explains how genetic risk is assessed. Prostate Cancer UK also has a simple online risk checker.
What to say to your GP
You can ask your GP about a PSA blood test even if you have no symptoms. It helps to mention:
- any urinary changes, however mild
- your family history of prostate, breast or ovarian cancer
- any other health concerns
Your GP may examine the prostate and arrange a PSA test. If the result or examination raises concern, you will usually be referred for an MRI scan of the prostate before any decision about a biopsy. Our guide to smart screening for prostate cancer describes a modern approach to early detection.
Finding cancer early makes a difference
When prostate cancer is found while it is still contained within the gland, there are more treatment options and the chance of cure is high. Some men with low-risk disease may not need treatment straight away and can be monitored safely. Others benefit from surgery or radiotherapy. Our prostate cancer page outlines the main approaches.
If you are worried about your risk, or you have symptoms you would like checked, Professor Prokar Dasgupta can see you at The London Clinic. Please contact the clinic to arrange an appointment.