Prostate Cancer: Early Signs, Who Is at Risk and Should You Have a PSA Test?

Prostate cancer is one of the most common cancers in men worldwide. Many prostate cancers grow slowly and may never cause harm, but some are aggressive. Knowing your risk helps you decide when to talk about testing.

At 52, a man with a father who had prostate cancer asks his nurse about testing. Because he asked, a slow-growing cancer is found early, while it can still be cured.

Early signs

In the early stages, there are usually no symptoms. When symptoms appear, they often affect urination:

• Needing to urinate more often, especially at night
• Difficulty starting or a weak flow
• Feeling the bladder has not emptied
• Blood in urine or semen (less common)
• Later: bone pain, back pain or weight loss

These urinary symptoms are much more often caused by an enlarged prostate, which is not cancer. See enlarged prostate (BPH). But they should still be checked.

Who is at higher risk?

• Men over 50, with risk rising with age
• Black men, who have a higher risk and are often diagnosed younger
• Men with a father or brother who had prostate cancer
• Men with inherited BRCA gene changes

The PSA test

The PSA blood test measures a protein made by the prostate. A raised level can suggest cancer, but it can also be raised by an enlarged prostate, infection or recent ejaculation. Some cancers are missed, and some are found that would never have caused harm. That is why most guidelines recommend a shared decision with a health professional, especially for men at higher risk.

If a test is abnormal

Further tests may include an MRI scan and a biopsy. Treatment depends on how fast the cancer is growing and may include active monitoring, surgery, radiotherapy or hormone therapy.

“But I have no symptoms, so I must be fine.”

Early prostate cancer usually causes no symptoms at all. That is why men at higher risk are encouraged to talk to a health professional about testing before symptoms appear.

Sources: World Health Organization / International Agency for Research on Cancer (GLOBOCAN 2022); NHS and US Preventive Services Task Force guidance on prostate cancer screening.