Alicia Morgans, MD, MPH: Prostate cancer is often diagnosed when men don’t have any symptoms at all. Sometimes we can diagnose it just by using the PSA blood test, which is measuring a protein, PSA, or prostate specific antigen, that is made by prostate cells and prostate cancer cells and circulates in the blood. In these settings, when that’s all that’s needed to diagnose a patient, that individual in most cases actually doesn’t have any symptoms.

If men do develop symptoms, the most common ones are those of an enlarged prostate, and that would be waking up more often at night to urinate because you’re not emptying your bladder all the way during the day or at night when you do go to the bathroom, and that residual urine that’s still in the bladder causes the bladder to fill up more quickly, so you have to go to the bathroom more often. Sometimes men also note that they have urgency. When they have to go, they have to get to the bathroom more quickly in addition to daytime urinary frequency. And sometimes men develop urinary tract infections, which are relatively more rare when they don’t have issues with their prostate. But when the urine is not draining properly, sometimes they can have urinary tract infections due to that urine sitting in the bladder for a longer period of time and not draining effectively or properly.

Unfortunately, when men have symptoms like pain in the back or pelvis or are losing weight, this is usually when the prostate cancer is much more advanced and has already spread outside of the prostate into things like bone and can be a situation that is much more difficult to treat and control. Men sometimes present to the emergency department with really intractable or difficult to deal with back pain or even paralysis of their legs when the prostate cancer is extremely advanced, and it’s more of an emergency in terms of needing to be treated. There’s a really big spectrum of what men may experience or not experience in terms of symptoms of prostate cancer. And hopefully we can do more screening to identify prostate cancer before it causes symptoms when it is much more easy to treat and hopefully cure.

The prostate-specific antigen, or PSA, blood test is the most common test that we use to screen for prostate cancer. It is pretty simply performed by drawing blood and measuring that, and an internist, primary care doctor, or urologist can interpret that level and help you understand if you need to have further testing to understand if you might have a prostate cancer diagnosis that needs to be made. Additionally, we use a digital rectal exam or DRE sometimes in primary care and certainly in urology clinics to feel the prostate. It’s a rectal exam with 1 finger that very quickly goes in, feels the prostate, which is right up against the rectum, to make sure that it is flat and smooth and not enlarged, pushing into the rectum, or bumpy. Because when it does feel abnormal, even when the blood test is not elevated, that could be a sign that there is a prostate cancer in the prostate and further workup is typically needed.

Transcript is AI-generated and edited for clarity and readability.