Prostate Cancer Symptoms and the Importance of the PSA Test

Prostate cancer is one of the most common types of cancer in men, often progressing silently in its early stages without causing any complaints. When prostate cancer symptoms—which can emerge with advancing age—are noticed, or when routine prostate screening is performed, the chances of successfully treating the disease are quite high. As part of Prostate Cancer Awareness Month in September, it is vital for men, especially those over 50, not to neglect their regular medical check-ups.

• Prostate cancer progresses silently in the early stages and may not show symptoms for a long time.
• It is recommended that every man from the age of 50 have a PSA test once a year.
• If there is a family history of cancer, screenings should begin at ages 40-45.
• Blood in the urine or a sudden inability to urinate requires emergency medical intervention.
• Thanks to early diagnosis, it is possible to successfully treat the disease.

What is Prostate Cancer?

The prostate is a walnut-sized gland that is part of the male reproductive system, located just below the bladder and in front of the large intestine. Its primary function is to produce a portion of the seminal fluid that nourishes and protects sperm. Prostate cancer occurs as a result of deterioration in the DNA structure of healthy cells within this gland and the uncontrolled multiplication of these cells. The disease generally has a slow-growing nature and can remain confined within the prostate gland for many years.

In Türkiye and around the world, it is the second most frequently diagnosed cancer in men after lung cancer. The slow-progressing nature of the disease provides a great advantage for early diagnosis. Through regular check-ups, abnormalities in the cells can be detected before they become cancerous or spread beyond the prostate. However, some aggressive types can spread rapidly to other organs. Therefore, even if you have no complaints, having a medical evaluation after a certain age is the most reliable way to protect your health.

Causes and Risk Factors

Although it is not known exactly why prostate cells begin to become abnormal, the main risk factors that play a role in the development of the disease have been clearly defined by the medical world. The most prominent risk factor is age; while the disease is rare in men under 50, the risk gradually increases as age advances. The vast majority of cases are detected in men aged 65 and over.

Genetic predisposition also plays a major role in the emergence of the disease. If you have a history of prostate cancer in your father, brother, or uncle, your chances of developing the disease are two to three times higher compared to other men. In addition, having a family history of breast or ovarian cancer (BRCA1 and BRCA2 gene mutations) is among the genetic factors that increase the risk. Dietary habits and lifestyle also affect the course of the disease. Excessive consumption of red meat, diets high in saturated fat, and obesity can trigger the development of cancer cells. Although smoking does not directly cause this cancer, it is an important factor that paves the way for the disease to progress more aggressively and makes the treatment process more difficult.

What Are the Symptoms of Prostate Cancer?

In the initial stage of the disease, because the tumor is very small, it does not press on the urinary tract or surrounding tissues. Therefore, it generally does not show any symptoms in the early stages. However, as the tumor grows and the prostate gland enlarges, various complaints begin to emerge in the reproductive and excretory systems. In the early period, mild signs such as difficulty starting to urinate, a weakened urine stream, or intermittent urination may be seen. The need to urinate frequently, especially waking up from sleep at night, is one of the most common complaints patients mention when consulting a physician.

When the disease progresses and prostate cancer symptoms intensify, more serious and uncomfortable clinical pictures emerge. The main symptoms that can be seen in advanced stages are:

• Visible fresh blood in the urine or semen (hematuria)
• A burning sensation and pain during urination or ejaculation
• The feeling that the bladder has not emptied completely and a constant urge to go to the toilet
• Deep, persistent pain in the lower back, hips, or thigh bones if the cancer has spread to the bones
• Unexplained weight loss, loss of appetite, and chronic fatigue

Many of these symptoms also show great similarity to different conditions such as benign prostatic hyperplasia (BPH) or urinary tract infections. To find the true source of the complaints, an evaluation by a specialist physician is absolutely necessary.

Diagnosis: How Is It Diagnosed at the Hospital?

One of the most important and first steps in diagnosing prostate diseases is the PSA (Prostate-Specific Antigen) value checked in the blood. Our patients frequently ask the question, "what is a PSA test?" PSA is a protein produced by the prostate gland, and it is completely normal for it to be present in the blood at a certain level. However, in cases such as cancer, severe infection, or prostate enlargement, the amount of PSA mixing into the blood increases. Although high PSA alone does not definitely mean cancer, it is an important warning sign for the physician that requires further investigation.

During the diagnosis process, in addition to the blood test, a physical urological examination (digital rectal exam) is performed. With this examination, the physician checks the size of the prostate, any hardness on its surface, nodules, or asymmetrical structures with a finger. If the examination findings and blood test results are found to be suspicious, a prostate biopsy is planned for a definitive diagnosis. Advanced imaging methods, especially Multiparametric Prostate MRI, pinpoint the location of suspicious cancer foci with millimetric precision. Then, using MRI-Fusion biopsy technology, tissue samples are taken directly from these suspicious areas and examined in the pathology laboratory. To learn more about the details of these processes, you can review our article titled Erkeklerde Sık Görülen Kanserler ve Tarama Testleri.

Treatment Methods and the Recovery Process

The treatment plan is determined personally based on the patient's age, general health status, the stage of the cancer, and the aggressiveness level of the tumor (Gleason score) determined as a result of the biopsy. Active surveillance may be preferred for low-risk, slow-growing tumors that do not threaten the patient's lifespan. In this method, the patient is not immediately subjected to surgical intervention; the course of the tumor is closely monitored with regular blood tests, examinations, and biopsies. If the disease shows signs of progression, active treatment is initiated.

In cases where surgical intervention is required, a radical prostatectomy surgery is performed, in which the entire prostate gland and some surrounding tissues are removed. In medical practice, these surgeries are generally performed closed using robotic surgery (da Vinci) or laparoscopic methods. Closed surgeries offer less bleeding, less pain, smaller incision scars, and a shorter hospital stay. The recovery process usually takes a few weeks, and patients can return to their daily lives in a short time. In addition to or as an alternative to surgery, radiotherapy (radiation therapy) and hormone therapy are also widely used. Hormone therapy aims to control the disease by lowering the testosterone level that feeds the growth of cancer cells. In cases where there is no cancer but rather a benign enlargement, different and minimally invasive methods such as İyi Huylu Prostat Büyümesinde Son Teknoloji: HoLEP Ameliyatı come into play.

Complications and Disease Progression

When prostate cancer is left untreated or noticed late, it carries the risk of spreading (metastasis) to surrounding tissues and distant organs. When cancer cells breach the prostate capsule, they generally spread first to regional lymph nodes, then to the skeletal system, especially the spine and hip bones. Bone metastases lead to severe pain and pathological bone fractures, seriously reducing the patient's quality of life. In advanced stage cases, if pressure on the spinal cord occurs, severe neurological complications such as loss of strength in the legs or paralysis can also develop.

Just like the disease itself, some of the treatments applied can also have side effects. Following surgical interventions or radiotherapy, conditions such as urinary incontinence and erectile dysfunction may occur due to the muscles or nerves that provide urinary control being affected. However, modern surgical techniques, especially the use of nerve-sparing approaches during robotic surgery, have greatly reduced the frequency of these complications. Such temporary problems that may arise after treatment can largely be brought under control with pelvic floor exercises and medical treatments.

When to See a Doctor?

The most correct approach for your prostate health is to participate in regular screenings without waiting for complaints to emerge. Every man over the age of 50 should have a prostate screening once a year, even if there are no symptoms. For those with a family history of cancer, it is recommended to start these check-ups between the ages of 40-45.

However, if you notice certain alarm symptoms in your daily life, you should apply to a healthcare institution without wasting time:

• Seeing fresh, red-colored blood in your urine or semen
• Severe burning, pain, or a sudden stoppage of the urine stream while urinating
• The need to urinate frequently enough to wake you up from sleep at night
• Persistent, aching bone pain in the lower back, hips, or thigh area

If you suddenly experience an inability to urinate (acute urinary retention), or feel excessive bloating and unbearable pain in your bladder, this is an emergency. In such a scenario, it is highly likely that the urinary tract is blocked. You should immediately go to the emergency department of the nearest hospital or call 112 to request medical assistance.

The Urology Process at BHT CLINIC

At the BHT CLINIC İstanbul Tema Hastanesi Üroloji clinic, we carry out all diagnosis and treatment processes for your prostate health at international standards. When you apply to our hospital, our specialist physicians perform a detailed physical evaluation and plan necessary blood tests such as PSA. In suspicious cases, thanks to our advanced MRI fusion biopsy technology, we make the most accurate and definitive diagnosis comfortably.

After diagnosis, our multidisciplinary council consisting of medical oncology, radiation oncology, and urology specialists creates the most appropriate and personalized treatment plan for you. Thanks to our robotic surgery infrastructure, we perform complex surgeries with high precision and accelerate your recovery process. Our hospital is by your side at all times with its emergency department providing uninterrupted service 24/7 against unexpected situations. When coming to our hospital to have your screenings done or to find a solution to your complaints, bringing your old test and imaging results with you will speed up the process.

Frequently Asked Questions

What should the PSA value be?

The PSA value varies depending on age and the volume of the prostate. As a general rule, although values below 4 ng/mL are considered normal, lower thresholds may be taken as a reference in younger patients. A high value alone does not diagnose cancer; your physician's overall evaluation is essential.

Can prostate cancer be completely cured?

Yes, when the disease is confined to the prostate gland and diagnosed at an early stage, the rate of successful treatment and recovery is very high. Cancerous tissues can be completely removed through methods such as surgery or radiotherapy. For this reason, routine screenings are life-saving.

Is frequent urination a definite sign of cancer?

No, frequent urination is generally a symptom of age-related benign prostatic hyperplasia (BPH) or urinary tract infections. However, since prostate cancer can also cause similar complaints, a differential diagnosis must absolutely be made by a urology specialist.

Is a prostate exam painful?

A physical urology examination (digital rectal exam) is generally painless and takes only a few seconds. Patients may experience a brief feeling of mild pressure, but this procedure is one of the most important and reliable parts of the diagnostic process.

My father has prostate cancer, when should I start screening?

Men with a history of prostate cancer in their first-degree relatives have a higher risk rate. Therefore, without waiting for the general screening age of 50, it is recommended that you have your first PSA test and urology examination between the ages of 40-45.

To avoid leaving your health to chance and to plan your regular check-ups, you can contact us through our appointment page.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.