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  1. Chris Dawson,
  2. Hugh Whitfield

    Symptoms and signs

    The symptoms and signs of prostate cancer are initially closely similar to those of benign prostatic hyperplasia—obstruction of the urethra by the malignant gland may lead to hesitancy, poor urinary flow, intermittent flow, post-micturition dribbling, and incomplete emptying. Secondary bladder instability may ensue and give rise to urinary frequency, nocturia, and urgency.

    Haemospermia

    • Patients with haemospermia often present to their general practitioner thinking that they may have cancer

    • Haemospermia is usually related to non- specific inflammation of the prostate and settles spontaneously

    The patient may also present with haematuria, typically reporting that the blood appears at the beginning of an otherwise clear urinary stream. Although this suggests a cause localised to the lower urinary tract, all such patients should be investigated and managed along the lines described for patients with haematuria (see next article in the series).

    Onset

    • Prostate cancer typically proceeds insidiously

    • Men often present late with advanced disease and symptoms resulting from bony metastasis or from anaemia of chronic disease

    Investigations of patients with suspected prostate cancer

    Investigations begin in the same way as for patients with benign prostatic hyperplasia—a full history of the main symptoms, followed by a thorough clinical examination and digital rectal examination. There are few clinical signs in early prostate cancer, but digital rectal examination will often detect an early lesion. In prostate cancer either the normal smooth surface of the prostate may be replaced by a hard nodule or the gland itself may be enlarged, hard, and “craggy” to the touch. The normal midline sulcus may be lost.

    The serum prostate specific antigen level should be established. Normal ranges depend on the assay used.

    Normal ranges for prostate specific antigen

    • Polyclonal assay 0-2.5 ng/ml

    • Monoclonal assay 0-4 …

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