Prostate carcinoma is the most common tumor disease in men. In the early stages of the disease, prostate cancer usually proceeds asymptomatically and does not cause any symptoms. There are also no typical warning signs that specifically indicate prostate cancer. Therefore, screening with the digital-rectal examination, which involves the doctor palpating the prostate via the rectum, and the determination of the PSA level (prostate specific antigen) in the blood is an important part of the early detection of prostate cancer. In Germany, men over 45 years of age have the opportunity to have their prostate examined annually by their doctor.
What symptoms may indicate prostate cancer?
Complaints that may indicate prostate cancer usually only occur at a more advanced stage. At the beginning of the disease, most patients are free of symptoms. The symptoms of prostate cancer are varied and not necessarily specific, as a number of other diseases also cause similar problems.
Men who suffer from one or more of the symptoms listed below should consult their family doctor or urologist immediately. Through appropriate examinations, the doctor can quickly determine whether prostate cancer is present or not. Typical symptoms include difficulty urinating and difficulty defecating.
The tumor on the prostate can constrict the urethra and press on the lower section of the rectum, making it difficult to empty the bladder and bowel. The affected patients feel an increased urge to urinate, especially at night. However, these symptoms also occur with benign enlargement of the prostate (prostate hyperplasia), from which many men suffer.
Pain during urination or ejaculation are further warning signs that the prostate may be diseased. Bloody admixtures in the urine (haematuria) or the seminal fluid can also indicate prostate cancer. In the more advanced stages, the tumor has often formed metastases that can deposit in various parts of the body and cause problems there.
Pain in the back or pelvic area can be caused by bone metastases, for example. and metastases in prostate cancerThe prostate lies behind the bladder and encloses the first section of the urethra. Tumors in the prostate usually originate from gland tissue (so-called adenocarcinomas) and develop in the outer zone of the prostate.
As the tumor grows, the urethra inside the prostate becomes increasingly narrow. As a result, patients have difficulty urinating. This is mainly manifested by a weak urinary stream and a constant urge to urinate, which is particularly noticeable at night.
Usually these problems only occur when the tumor is already relatively large and the disease is in an advanced stage. The narrowing of the urethra due to the prostate carcinoma also causes pain when urinating. A complication of the urinary blockage is acute urinary retention, in which the bladder continues to fill up, but urine can no longer be passed through the tumor.
Acute urinary retention is extremely painful. Those affected feel a feeling of pressure in their abdomen and can no longer urinate. Acute urinary retention is an absolute emergency that requires immediate medical treatment.
During ejaculation, the muscle cells in the prostate contract, causing a secretion that keeps the sperm mobile to reach the seminal fluid in the urethra. A tumor in the prostate may cause pain due to the contraction just before or during ejaculation. The pain is described as stabbing and very unpleasant and is mainly felt in the area between the scrotum and anus.
Pain during ejaculation is in most cases due to diseases of the prostate and should be clarified by a doctor. Blood in the urine (haematuria) or in the seminal fluid (haematospermia) can be a sign of a tumor in the prostate. The invasive growth of the tumor into the surrounding tissue of the prostate can destroy blood vessels, from which blood then leaks.
As a result, the urine or semen may become red or brownish in color. Blood in the urine or seminal fluid can also have more harmless causes, such as inflammation of the prostate (prostatitis) or the urethra (urethritis). Nevertheless, this symptom is a warning sign and urgently requires a visit to a doctor.
Prostate cancer can cause pain in the prostate, although this is usually a later symptom of the disease.The tumor grows, breaks through the capsule around the prostate and spreads to the surrounding tissue, causing pain. Often the pain is aggravated when urinating or during ejaculation. The pain occurs mainly between the testicles and anus, in the so-called perineal area, and is perceived as stinging or burning.
Very often, however, prostate pain is caused by other factors, such as irritation or bacterial inflammation of the prostate. Cold, prolonged sitting or alcohol consumption can also lead to complaints of the prostate. In addition to pain during ejaculation, a tumor in the prostate can also affect the ability to have an erection.
In such cases, the growth of the prostate carcinoma damages nerves and blood vessels that are responsible for the development of an erection, resulting in erectile dysfunction (impotence or erectile dysfunction). The narrowing of the urethra also means that less seminal fluid is discharged. In the case of erectile dysfunction, men over 45 years of age should always be examined for prostate cancer.
An important symptom of prostate cancer is problems with bowel movements. Due to the growing tumour, the prostate gland presses more and more on the rectum behind it, making it difficult to defecate. The affected persons suffer from irregularities in their stools and pain during bowel movement.
In advanced stages, prostate carcinoma can develop daughter tumors (metastases), which very often settle in the bone (osseous metastasis) and cause discomfort there. The tumor tissue presses on the periosteum, which is sensitively supplied by many nerves. The men affected then feel severe pain in their lower back at the lumbar spine or hip, which can radiate into the legs.
However, back pain is not a particularly specific symptom of prostate cancer and very often has other, harmless causes. In addition to back pain, metastatic prostate cancer can also cause numbness, sensory disturbances and even paralysis. This is because bone metastases in the spine can press on the spinal cord and cause these complaints.
Spontaneous bone fractures, for which there is no explanation, can also be an indication of osseous metastasis. If osseous metastases are suspected, patients with prostate carcinoma undergo an x-ray of the spinal column and a whole-body bone scintigraphy. With these two examination methods, metastases in the bone can be reliably diagnosed.
Fever is a symptom that generally occurs very frequently in all forms of cancer and also in prostate cancer. Together with night sweats and unintentional weight loss, physicians refer to this triad of symptoms as the so-called “B-symptomatics”. Patients have a fever of more than 38 degrees, which persists for a long time and cannot be attributed to any other cause (e.g. an infection).
It is assumed that the fever is a reaction of the body against the tumor cells. The immune system attacks the tumor cells and releases certain substances, so-called pyrogens, which trigger fever attacks. Patients with prostate cancer often suffer from persistent fatigue and listlessness.
This form of fatigue is also known as chronic fatigue syndrome. It is an extreme fatigue that does not disappear with sleep and rest. Fatigue occurs in many tumor diseases, although the exact causes are still unknown.
The fatigue is perceived by those affected as very distressing and leads to severe restrictions in their everyday life. Drugs and non-drug treatment approaches (e.g. endurance sports and relaxation techniques) can help to alleviate the fatigue. In addition to fatigue syndrome, tumor-associated anemia can also be a cause of fatigue. Due to the lack of blood, patients feel exhausted and worn out. In such cases, blood transfusions or drugs that support blood formation help.
