Prostate cancer mostly originates in the peripheral zone of the prostate, so the disease is usually insidious and grows slowly, so early prostate cancer can be asymptomatic.
Note that early prostate cancer has no symptoms!
Many patients are still confused or shocked when they are told they are diagnosed with prostate cancer, “I don’t feel anything, how can I have cancer” and can’t accept it inside. Some patients are found to have elevated serum prostate specific antigen (PSA) values or abnormalities in the prostate on rectal exam and ultrasound.
This is why regular checkups and early screening are so important!
Once there are detectable symptoms, it is often a more advanced form of progressive prostate cancer. The main symptoms include:
Local symptoms
If the prostate tumor is progressively enlarging and compressing the urethra of the prostate gland, it may cause urinary disturbance, which may be progressive (thinning of the urine stream, skewed urine stream, bifurcation of the urine stream or prolonged urination), frequent urination, urgent urination, painful urination, incomplete urination, and in severe cases, dripping and retention of urine. These symptoms are similar to those of benign prostatic hyperplasia and are easily misdiagnosed and missed.
Second, a small number of patients will have hematuria and hematospermia. The hematuria is due to tumor invasion of the bladder neck of the posterior urethra, and the hematosperm is due to tumor invasion of the seminal vesicles; some patients will have decreased semen volume.
Metastatic symptoms
When prostate cancer metastasizes to bone, it can cause bone pain at the metastatic site. Common sites of bone metastases include the spine, hip, ribs, and scapula. About 60% of patients with advanced disease develop bone pain, commonly in the low back, sacrum, buttocks, and hip pelvis.
Advanced prostate cancer with spinal metastases can lead to nerve compression and subsequent paralysis if the spine is fractured or the tumor invades the spinal cord, requiring immediate emergency hospital care.
Lymph node metastases usually do not cause symptoms, and many patients have lymph node metastases at the time of initial presentation. They tend to occur in the internal iliac, external iliac, retroperitoneal, inguinal, mediastinal, supraclavicular, and, in rare cases, leg swelling due to compression of blood vessels and obstruction of lymphatic return to the lower extremities.
If prostate cancer invades the base of the bladder or metastases extensively in the pelvic lymph nodes, unilateral or bilateral ureteral obstruction can occur. Signs and symptoms of ureteral obstruction include oliguria, low back pain, nausea, vomiting, and fever in the setting of co-infection.
Systemic symptoms
For advanced progressive prostate cancer symptoms such as fatigue, weight loss, and generalized pain can occur. As the pain severely affects diet, sleep, and spirit, the patient will become increasingly weak, lethargic, progressive anemia, and eventually cachexia due to systemic failure after prolonged torture.
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