Prostate Cancer: Early Warning Signs Men Should Never Ignore

There is a pattern I have seen many times with men. They notice that they are getting up more often at night to urinate, their urine stream has become weaker or they are finding it difficult to empty their bladder, but they simply accept it as part of getting older.

“I am 60 now, doctor. This is normal.”

Sometimes it is. An enlarged prostate, known as benign prostatic hyperplasia or BPH, is extremely common as men age and can cause many of these urinary symptoms. But sometimes, these changes need to be investigated for another reason.

That is the conversation we need to have about prostate cancer.

Prostate Cancer Is More Common Than Many Men Realise

Prostate cancer is one of the more common cancers affecting Indian men. According to GLOBOCAN estimates for India, there were approximately 37,948 new prostate cancer cases and 18,386 deaths in 2022.

Yet men often do not talk about their prostate health until there is a problem.

There is also a common misconception that prostate cancer always causes urinary symptoms. It does not. Early signs of prostate cancer may be absent altogether, which is one reason discussions about risk and appropriate screening are important.

“I Thought It Was Just Because I Was Getting Older”

I remember speaking to a man who had been waking up several times every night to urinate. He had been living with it for months and had gradually changed his routine rather than getting it checked.

Frequent urination, a weak or interrupted urine stream, difficulty starting urination or feeling that the bladder has not emptied completely can have many causes. BPH is much more common than prostate cancer as a cause of urinary symptoms.

But something being common does not mean it should automatically be assumed to be harmless. A proper evaluation can tell us what is actually happening.

What Are the Prostate Cancer Symptoms?

One of the difficulties with prostate cancer is that there may be no early signs of prostate cancer at all.

When symptoms do occur, prostate cancer symptoms can include difficulty urinating, a weak or slow urine stream, needing to urinate more frequently, particularly at night, or blood in the urine or semen.

These symptoms do not mean a man has cancer. Many are more likely to be caused by non-cancerous prostate enlargement or other urinary conditions. But persistent or new symptoms should not simply be dismissed as ageing.

There is another reason not to wait for symptoms: screening can sometimes identify prostate cancer before it produces noticeable problems.

The PSA Test: Useful, But Not a Cancer Test

Most men have heard of the PSA test, but there is often confusion about what it actually tells us.

PSA stands for prostate-specific antigen, a protein produced by cells in the prostate. A blood test measures the amount of PSA in the blood.

A higher PSA can increase the possibility of prostate cancer, but it does not prove that a man has cancer. PSA can also rise because of an enlarged prostate, inflammation and other non-cancerous conditions.

So I would not advise men to look at a PSA number in isolation and either panic or dismiss it. The result needs to be interpreted alongside age, symptoms, family history, examination and other clinical findings.

Should Every Man Get Prostate Cancer Screening?

This is where the conversation needs to be more individual.

Prostate cancer screening is not simply a matter of saying, “Every man above a particular age must get a PSA test every year.” Screening has benefits, but it also has limitations, including false-positive results and the possibility of detecting slow-growing cancers that may never have caused a problem.

Men should discuss screening with their doctor based on their age, overall health, family history and individual risk.

Men with a close family history of prostate cancer may need to start these conversations earlier. Certain inherited genetic factors can also increase risk.

The important thing is to make an informed decision rather than avoiding the subject completely or getting tested without understanding what the result could mean.

Family History Matters

If your father or brother had prostate cancer, particularly at a relatively young age, that information should not be ignored.

Family history can increase a man’s risk, and inherited genetic changes can also play a role in some families.

This does not mean that a man with a family history will definitely develop prostate cancer. It means his risk may be different from another man’s and that he may benefit from an earlier or more individualised discussion about screening.

Sometimes, the most useful health information a son can have is simply knowing what happened to his father.

When Prostate Cancer Spreads

Advanced prostate cancer can behave very differently from early disease.

If the cancer spreads outside the prostate, particularly to the bones, a man may develop persistent pain in the back, hips, pelvis or other areas. Advanced disease can also cause weakness or numbness if cancer affects the spine, along with weight loss or significant fatigue.

These are not symptoms to watch at home for weeks. A persistent unexplained symptom needs medical attention, particularly in an older man or someone already known to have prostate problems.

If It Is Cancer, Treatment Is Not the Same for Everyone

Hearing the words “prostate cancer” can immediately make a man think about surgery.

But surgery is not automatically the answer for every patient.

Some cancers grow slowly and may be managed initially with active surveillance, while others require treatment. Depending on the stage and characteristics of the cancer, treatment can include surgery, radiation therapy, hormone therapy and, in selected situations, other systemic treatments.

The decision depends on the cancer’s biology, stage, the man’s age and overall health, and what is most appropriate for him.

That is why diagnosis is not the end of the conversation. It is the beginning of a much more personalised one.

Men Are Often Good at Ignoring Their Own Health

Perhaps this is the part I find most frustrating.

Many men will take their wife or children to the doctor immediately if something seems wrong. But when it comes to themselves, they often wait until the problem interferes with everyday life.

Urinary changes become “age.” Back pain becomes “work.” Fatigue becomes “stress.”

Sometimes those explanations are correct. But sometimes they are not.

If you are noticing persistent changes in urination, blood in your urine or semen, unexplained pain or other changes that concern you, do not simply assume that they are part of ageing.

Even without symptoms, talk to your doctor about whether prostate cancer screening is appropriate for you, particularly if you are older or have a family history.

Don’t Wait for Your Body to Shout

Prostate cancer is often quiet in its early stages.

Awareness should therefore not be about waiting for a dramatic warning sign. It should be about knowing your risk, understanding prostate cancer symptoms that deserve attention and having an informed conversation about screening when appropriate.

Men spend years taking care of their families, careers and responsibilities.

Your health needs to be one of those responsibilities too.

If something has changed, get it checked. If you have a family history, talk about it. If you are at an age where screening may be appropriate, have the conversation.

You do not need to be frightened of prostate cancer.

But you should not be afraid to talk about it either.

Dr. Mohana Vamsy