Warning Signs of Prostate Cancer

Your prostate grows as you get older. In fact, about half of men in their 50s and up to 90 percent of those in their 80s have benign prostate growth, or prostate enlargement. As it enlarges, this gland squeezes and narrows your urethra ­— the tube urine passes through to leave your body. BPH is more annoying than harmful, and it’s very treatable.

Prostate cancer is common, too, affecting an estimated 1 in 8 men in their lifetime. An estimated 299,010 new cases of prostate cancer will be diagnosed in 2024, according to the American Cancer Society. Yet its symptoms typically don’t appear until late in the disease, once the cancer has already spread. Along with urinary symptoms, late-stage prostate cancer can cause bone pain, weight loss and back pain. “Again, pretty generic symptoms that can be hard to recognize and that most of the time represent something totally different,” Morgan says.

Deciphering symptoms

It’s never a good strategy to self-diagnose. When you have warning signs that suggest BPH or cancer, a trip to your primary care provider or urologist is in order. Along with either reassuring you that what you have is benign or pointing you to treatment if it’s cancer, your doctor can offer therapies to relieve those uncomfortable urinary symptoms so that you can sleep again.

Your doctor may start the evaluation by considering your risks for prostate cancer. Age is a big factor. Only about 1 in 456 men are diagnosed before age 50. By age 70, the odds jump to 1 in 11 men. A family history — not only of prostate cancer but also of breast, ovarian, pancreatic or colon cancer — increases your risk as well.

Race matters too. “African American men have a higher risk of prostate cancer diagnosis and a more aggressive prostate cancer and higher risk of death, compared to non-Hispanic white men,” explains Justin R. Gregg, M.D., assistant professor of urology and a health disparities researcher at the University of Texas MD Anderson Cancer Center.

The diagnosis

The evaluation for prostate cancer includes a prostate-specific antigen, or PSA, blood test. If you’re in your 50s or 60s, you may have already had one or more of these screening tests, which measure a protein produced by prostate cancer cells. The problem is that normal prostate tissue also produces this protein, which can lead to false-positive results.

“It’s not a perfect test,” Morgan says. “Many men with an elevated PSA don’t have prostate cancer.” An elevated PSA result could prompt your doctor to have you undergo a magnetic resonance imaging (MRI) scan or biopsy for a cancer that doesn’t exist. And even if these tests detect prostate cancer, it could be the slow-growing kind that will never cause problems or need treatment.

The U.S. Preventive Services Task Force (USPSTF) recommends against PSA tests for men age 70 and older. For men ages 55 to 69, the task force suggests discussing potential harms and benefits with a health care provider. The American Cancer Society recommends having that discussion with your doctor starting at age 50.

“Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men,” the USPSTF wrote in its 2018 recommendation, adding that false-positive results can lead to “additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction.”

Still, the PSA test has its benefits. “If we detect a prostate cancer that has not spread but has the potential to be harmful in the future, we can recommend treatments to potentially cure the cancer,” Gregg says.

Adding a digital rectal exam (DRE) can help your doctor fine-tune the diagnosis. “Larger prostates are more likely to be large because of BPH rather than prostate cancer,” Morgan says. “It’s because BPH also causes PSA to rise.” A firm lump will point your doctor in the direction of cancer, even if you have a low PSA level.

A strong suspicion of prostate cancer after a DRE and a PSA test will usually lead to an MRI, which highlights any questionable spots. If something suspicious shows up on the MRI, a biopsy can confirm the diagnosis.

To treat or not to treat?

That is the question, and the answer depends on the results of your Gleason score. This scale, which goes from 6 to 10, grades your cancer based on how different the cells look from normal prostate cells. “The Gleason 6 cancers, which are very common, are the lowest kind of prostate cancer,” Morgan says. “It’s basically impossible for them to leave the prostate.”

Treating a low-grade cancer that’s unlikely to spread could unnecessarily expose you to the risks of surgery and radiation, though newer, more precise procedures have become available. Instead, your doctor may recommend active surveillance.

“Usually, it’s a visit to the urologist every six months or so, following the PSA blood level, doing rectal exams and possibly doing MRIs and additional testing to monitor the prostate cancer,” Gregg says. You’ll also get occasional biopsies to make sure the cancer cells haven’t turned aggressive; if they have, your doctor will upgrade you to treatment with prostatectomy surgery or radiation therapy.

Older men may get by with watchful waiting, instead of active surveillance. Though the terms sound similar, the approach is slightly different. Watchful waiting is a more laid-back strategy that includes a yearly PSA test but little else. “It’s a term that’s applied to patients who are older, where it’s really unlikely that surgery or radiation is ever going to be recommended,” Morgan says. “If somebody has a life expectancy of less than 10 years, even if the cancer changes, they’re likely not going to need treatment.”

Don’t rely on symptoms

If you’re in your 50s or 60s, prostate cancer should be on your radar. Ask your doctor about your risks and whether you should undergo a PSA screening.

Because symptoms often don’t appear until this cancer has spread and is harder to treat, a PSA screening can be valuable. “It allows us to pick up cancer many years earlier than we would otherwise,” Morgan says.​

Editor’s note: This story, first published Aug. 18, 2022, has been updated to include new information.