Health Information

Symptoms and signs

Most prostatic cancers are detected in asymptomatic men who are found to have focal nodules or areas of induration within the prostate at the time of digital rectal examination.
Rarely, patients present with signs of urinary retention (palpable bladder) or neurologic symptoms as a result of epidural metastases and cord compression. Obstructive voiding symptoms are most often due to benign prostatic hyperplasia, which occurs in the same age group. However, large or locally extensive prostatic cancers can cause obstructive voiding symptoms. Lymph node metastases can lead to lower extremity lymphedema. As the axial skeleton is the most common site of metastases, patients may present with back pain or pathologic fractures.

Miscellaneous laboratory testing

Patients in urinary retention or those with ureteral obstruction due to locally or regionally advanced prostatic cancers may present with elevations in serum urea nitrogen or creatinine. Patients with bony metastases may have elevations in alkaline phosphatase or hypercalcemia. Laboratory and clinical evidence of disseminated intravascular coagulation can occur in patients with advanced prostatic cancers.

Prostatic biopsy

Transrectal ultrasound guided biopsy seems to be a better method for detection of prostatic cancer than finger guided biopsy. The use of a spring-loaded, 18-gauge biopsy needle has allowed transrectal biopsy to be performed with little patient discomfort and low attendant morbidity. The specimen preserves glandular architecture and allows for accurate grading as described below. Taking biopsy specimens from the apex, midportion, and base of the prostate is recommended by some and should be considered in patients with significant elevations PSA but a normal digital rectal examination. Patients with abnormalities of the seminal vesicles can have guided biopsies of these structures performed to allow for detection of local tumor invasion. Aspiration biopsies of the prostate, through accurate and associated with low morbidity, have been used rarely since the introduction of the spring loaded biopsy device but should be considered in patients at an increased risk of bleeding.