Prostate Cancer: Symptoms & Complications

W orldwide, prostate cancer is the most common cancer that affects men.

In many cases it is not a very aggressive cancer and men may live for years after being diagnosed with prostate cancer. However, in other cases it may be more aggressive and require major surgery or other treatments.

1How is prostate cancer diagnosed?

1. Symptoms

Most men with prostate cancer have no symptoms as prostate cancer causes symptoms only when it is advanced. In such cases, it may cause low back pain or difficulty with urination. All men who have difficulty with urination do not necessarily have prostate cancer. A non-cancerous enlargement of the prostate, also known as benign prostatic hyperplasia, is much more common and often causes difficulty with urination.

2. Blood test (PSA)

Prostate Specific Antigen (PSA) is a blood test that is used to identify patients at risk of having prostate cancer. Patients with high PSA have a higher risk of prostate cancer. Your doctor will help you to interpret the PSA test as the PSA count can sometimes be high in non-cancerous conditions.

3. Finger test called Digital Rectal Exam (DRE):

Your doctor will use an index finger and place it into the anus to feel the prostate. This enables assessment of prostate size, consistency (hard or soft) and the presence of nodules (lumps).

4. Prostate biopsy4.

Prostate biopsy (also referred to as TRUS biopsy) is done by inserting an ultrasound guided biopsy probe (more or less the size of an index finger) into the anus and then taking small pieces of the prostate for pathology examination in a laboratory. This is the most accurate test for making a diagnosis of prostate cancer. Prostate biopsy is done under local anesthesia or general anesthesia depending on the preference of the patient. It is a short procedure that normally does not require an overnight stay in hospital.

After the prostate biopsy, the samples of prostate tissue taken during biopsy are sent to a pathologist who determines the presence or absence of prostate cancer as well as the aggressiveness of cancer. Your doctor needs the pathology results to appropriately advise you about the treatment options.

2What are the risks of a prostate biopsy?

Infection

Infection of the prostate can occur after biopsy. The signs of infection include fever, nausea, chills, severe pain in the area of the anus and painful urination. You doctor will give you antibiotic before and after biopsy to reduce the chance of getting infection after biopsy. If you develop these symptoms after biopsy, contact your doctor for appropriate advice.

Bleeding

Passage of blood in the stool and urine is not unusual after prostate biopsy and usually stops without any treatment. Heavy bleeding after prostate biopsy is extremely rare.

Blood in the semen

Some patients report blood staining of semen after prostate biopsy. In some occasions this may persist for 4-6 weeks and will also abate spontaneously.

3What are the options for treatment of prostate cancer?

Treatment of prostate cancer depends on many factors:

  • The size and aggressiveness of your cancer.
  • The degree of advancement / spread of the disease.
  • Your general health.

Your urologist will discuss this with you and assist you in making make the best choice based on your individual circumstances. Treatment options include:

Surgery: Radical prostatectomy

Surgical removal of the prostate with the aim of total cure of prostate cancer. Prostate cancer surgery is done for patients with cancer that has not spread to the rest of the body and who are healthy enough to withstand a big operation.

Radiation therapy: External beam

Radiation of the prostate with the aim of total cure of prostate cancer. The advantage above surgery is that you do not need to undergo a big operation. However, radiation therapy is not without risks and side-effects.

Radiation therapy: Brachytherapy

This is a form of radiotherapy where small beads of radioactive materials are inserted into the prostate to kill cancer cells. This form of treatment is best suited for individuals who have small prostates and prostate cancer which has not spread to the rest of the body.

Active surveillance

Mostly for non-aggressive prostate cancer in younger men. Involves yearly follow up with blood test (PSA), MRI scan and biopsy of the prostate.

Watchful waiting

Mostly for advanced prostate cancer in older men. Involves doing nothing unless the prostate cancer causes symptoms. Your urologist will see you every few months for a check-up.

Hormone treatment

Prostate cancer cells depend on male hormones such as testosterone for growth. Removal of testosterone from the body slows down the growth of prostate cancer.

Chemotherapy

Chemotherapy is mostly used for patients with advanced prostate cancer.