My brother is over the age of 50, making frequent trips to the bathroom during the night? these symptoms may indicate that he has a non-cancerous enlargement of the prostate or a cancerous enlargement of the prostate, how to determine , is there any other symptoms?

Sheryl's answer pretty much covered it and I want to add my 2 cents. A visit to the urologist for a PSA test and if suggested by the findings of the PSA, a biopsy to confirm/rule out cancer is really the only sure way. I had a lot of trouble with the first doctor I saw who neglected to refer me to a urologist ( I was almost 60 and my prostate was only slightly enlarged so he apparently felt no need to tell me about it) and further trouble with the first urologist I DID get to see over a year later. looking back, the worst mistake I made in handling my prostate cancer was my hesitancy to go to a different urologist. Be very proactive and don't only request the test, demand it if necessary! Best wishes for preferably a non-cancer diagnosis and if cancer is diagnosed, that it is caught early.

You can check cancerssociety.org/ for detail info

I have had these symptoms for a cpl yrs now, I have frequent urge to urinate, I have a very weak flow, when I try to pee in the toilet it is difficult, cause I cant control my stream, plus it will get slow then speed up.

You have many of the classical symptoms of enlarged prostate. You can treat it with natural supplements or prescription drugs.

But, just to be sure, go see your physician who can rule out other issues like prostate cancer.

For more information on this important subject, go to prostateenlargedsymptoms.com .

Best wishes to you!

ya prob have BPH,swellinfg…..new meds will shrink it…..go see uro doc asap…….
also need PSA TEST……..

For the sake of marital harmony, people ?occasionally do things they would rather avoid. That’s why retired ?business consultant Simon D’Arcy went to his doctor for a PSA test. He is glad he did, as is his wife, Gina, because that simple blood test saved his life.

It detected signs of a cancer which is so common that three men in Simon’s family have been struck by it (they are not related by blood).

Prostate cancer kills one man every hour in the UK, yet seven out of 10 who are at risk know nothing about the test.

In the clear: Gina and husband Simon D’Arcy, who had no symptoms. a PSA test revealed he had prostate cancer

The prostate is a tiny gland, around the size of a walnut, located around the urethra, which makes the fluid that carries semen.

The PSA test measures levels of a protein produced by the cells of the prostate gland — prostate specific antigen (PSA) — in the blood. Raised levels can be a sign of a ?problem, which may be cancer.

‘I had no idea what a PSA test was,’ admits Simon, 59, from Headley, Hants. ‘my wife is a practice nurse and two years ago, when I was going to my GP for a blood pressure test, she told me to ask for the PSA test too. I now know the chances of developing prostate cancer increase with age, but I had no symptoms.

‘I was a fit, active, non-smoker. I couldn’t see the point. my brother-in-law Charles had died from it 14 years earlier at 46 but I thought that was an unlucky one-off. I thought if I had cancer, I’d know about it. I was wrong on both points.’

To Simon’s surprise, his PSA reading was high. Two subsequent tests were higher still, and his GP referred him to Haslemere Hospital in Surrey. Gina, 55, advised him not to worry.

‘she explained that there was no reason to expect it to mean cancer,’ says Simon. this is the problem with the test: the results are never clear-cut. Raised levels of PSA can be a sign of prostatitis (often caused by an infection) or benign prostatic hyperplasia, a relatively harmless and fairly common condition in which age and hormones cause the prostate to enlarge.

Complicating matters further, prostate cancer can range from an aggressive form which kills, to a much more common cancer which is so slow-growing most men will die of other causes. The PSA test can’t differentiate between the two, which means men may end up having unnecessary treatment.

This includes radiotherapy, which can lead to bowel and ?urinary problems; hormone therapy, which may cause loss of libido and fatigue, and surgery, which can lead to erectile ?dysfunction and incontinence.

For these reasons the test has been the subject of debate for years among medical professionals. some doctors are ?reluctant to offer it: a survey last year by the Prostate Cancer Charity showed that one in five men who requested the test had been turned down by their GP.

Earlier this month health authorities decided against a national screening programme using the test because the risks posed are greater than potential benefits, the UK National Screening Committee said.

This announcement was described as ‘extremely disappointing’ by John Neate, the chief executive of the Prostate Cancer Charity.

However, experts believe all men should be informed about the test and make their own decision about whether to have it.

‘While there are benefits, there are risks of over-diagnosis and over-treatment,’ explains John Anderson, consultant urological surgeon at Sheffield Teaching Hospitals.

Unnecessary? Most men who have the test do not have cancer but go through the fear (posed by model)

‘a European screening study of 200,000 men, published last year inthe new England Journal of Medicine, showed a reduction in the numberwho died from prostate cancer among those who had the test, but therewas also an enormous incidence of over-diagnosis. Forty-eight men weretreated to save one from death.’

Dr Richard Ablin, researchprofessor at the University of Arizona, is the man who identified the?antigen. ‘I believe testing for PSA in healthy men has been a hugewaste of money and led to many men being left unnecessarily frightened,frustrated, impotent and incontinent,’ he wrote in the Daily Mail lastyear.

‘The majority of these patients could have lived painlessly with their tumours until the natural end of their lives.’

Simon takes a different view. His high test results led his consultant to recommend a biopsy.

‘The whole thing brought back vivid memories of Charles’ death. I felt very vulnerable and thought: am I going to go through the same thing?’ Simon recalls. ‘He was incredibly fit, had three teenage children with my sister Sarah and had settled in

Wiltshire where he was a ?senior partner at a GP surgery.

‘one somehow felt that as a GP he’d have spotted the symptoms and known — but like me, he didn’t have any. Charles died three years after the diagnosis.’

Simon and Gina discussed his condition with their three children, then aged 26, 24 and 22, and he had the biopsy at the Royal Surrey Hospital in Guildford.

When he returned with Gina to get his results on Valentine’s Day last year his consultant confirmed that he had moderately aggressive prostate cancer.‘On the way home in the car I was angry,’ he remembers.

‘why didn’t men know more about this cancer? my stepfather had died two years before in his 90s, and died with the disease rather than of it, but it brought it home to me how common this is.’

In a four-hour keyhole procedure, Simon’s prostate was removed in August last year. ‘I woke up feeling tremendously relieved. They’d managed to avoid most of my nerves, so side-effects should be minimal.

‘Three days later I was out of hospital. I did experience a little incontinence, but things were soon back to normal.’

Two weeks later the surgeon confirmed that there was no ?evidence the cancer had spread, though it was only just ?contained within the prostate.

Simon will have regular PSA tests for three years to check the cancer has not returned, and in response to the experience he has retired to spend more time with his family and doing the things he loves. this summer he sailed solo around the UK in a 24ft Cornish Crabber to raise awareness of the test and highlight that it is available to men over 50 in request from their GP.

‘I understand the test is controversial and not right for everyone, but I believe men ought to know about it,’ says Simon. ‘It’s an absolute tragedy that it won’t be used for national screening.

‘The utterly shocking thing is that I was not in an at-risk group and I had been living a normal, symptomless life with this ?cancer for four or five years.

‘Had I ignored my wife’s ?suggestion to have the test, the cancer would have spread outside the prostate in the not-too-distant future. that is a terrifying thought.’ n To find out more, go to ?prostate-cancer.org.uk or call 0800 074 8383.in the clear: Gina and Simon D’Arcy, who had no symptoms

Published on Wed Dec 22 10:16:41 GMT 2010

“Hopes rise for a personalised test for prostate cancer,” according to the Daily Mail. The newspaper says that the blood test routinely used to spot signs of the cancer can be made more accurate if it is used in conjunction with a man’s genetic information.

This news is based on research that looked at improving the predictive power of the prostate-specific antigen (PSA) test commonly used to help detect prostate cancer. When used alone the test can be unreliable as PSA levels, which may indicate cancer, can be raised by a number of factors, such as benign prostate growth or medication use. Equally, not all prostate cancer leads to raised PSA levels. Bearing in mind the limitations of the PSA test, the researchers performed a number of genetic analyses to identify mutations linked to high PSA and prostate cancer. They found that combining genetics with PSA results was more accurate than relying on the test alone.

This type of study is a useful foundation for improving the performance of the PSA test. Further research in this area would need to optimise the performance of the test and assess its ability to reduce prostate cancer deaths before it could be widely used as a screening tool.

The study was carried out by researchers working for deCODE genetics, a private company in Iceland, and collaborators from universities in Cambridge, Spain, Romania, USA and the Netherlands. No funding sources were reported. It was published in the peer-reviewed journal Science Translational Medicine.

The research was covered well by the Daily Mail, which reflected the current problems with the PSA test well and highlighted the preliminary nature of this research.

The prostate specific antigen (PSA) is a protein released by cells in the prostate gland. It can be used to test for prostate cancer as some men with prostate cancer have raised PSA levels. however, while some have suggested that a PSA test could be used as a mass screening tool (given to all men regardless of the presence of symptoms), the issue is controversial as the test only has moderate accuracy. This is because PSA levels naturally vary between men, and PSA is not a very specific marker for prostate cancer, as levels may rise following benign changes to the prostate, some medications or inflammation. This means that in a considerable proportion of men the PSA test fails to detect the disease and in others it gives false positive results.

The researchers report that around 40% of the variation in PSA levels is due to inherited factors. in this research they sought to look at the DNA of a large group of men to see whether they could identify SNPs (single ‘letter’ variations in their genetic code) that were associated with high or low PSA levels. They hoped that any variants identified could be used to adjust PSA test results to account for the inherited variation in PSA levels, making it a better predictor of which PSA increases were specifically due to cancer.

The researchers had access to information on PSA values from 15,757 Icelandic men who had been tested from 1994 to 2009, and did not have prostate cancer. They also had similar samples from the Prostate Testing for Cancer and Treatment trial, which was carried out in the UK. This included data for:

• 524 men with PSA values greater than three nanogrammes (ng)/ml who were diagnosed with prostate cancer after a needle biopsy of their prostate
• 960 men with PSA values between 3 and 10ng/ml prostate cancer who were confirmed as not having prostate cancer after they were given a biopsy
• 454 men with PSA values less than 3ng/ml who had not undergone biopsy

There is no consensus on the best threshold PSA level above which men should be given a biopsy to test for prostate cancer, but PSA levels in the range of 2.5–4ng/ml are commonly used.

With the data from the Icelandic men, the researchers performed a genome-wide association study to look for small variations in the genetic sequences of the men’s DNA, which they could then relate to each man’s PSA values. They then looked at whether any SNPs were associated with having a negative prostate biopsy result in 3,834 men who had biopsies. This was to determine whether men with raised PSA levels due to their genetic make-up were having biopsies that turned out to be unnecessary.

They also looked at whether the SNPs identified were also associated with risk of prostate cancer, by looking at their presence in 5,325 prostate cancer cases and 41,417 unaffected control subjects from Iceland, the Netherlands, Spain, Romania and the United States.

Finally, they used the genetic variations they identified to determine what PSA level was “normal” for each individual and whether accounting for genetics would improve the ability of the PSA test to distinguish between men with and without prostate cancer. They also looked at whether adding genetic information about 23 genetic variants associated with prostate cancer in other studies would also improve the ability of the PSA test to distinguish between men with and without prostate cancer.

In the genome-wide analysis they found that variations in six regions of DNA were associated with men’s PSA levels. They found that the strongest association was for variations in a region of DNA containing the gene that encodes the PSA protein (a site called KLK3). These variations were estimated to account for about 4.2% of the variability in PSA levels in the Icelandic sample, and 11.8% of the variability in the UK sample.

Among 3,834 men who underwent a prostate biopsy, they found that three of these variations were also associated with having a negative biopsy for prostate cancer. The researchers calculated an odds ratio between 1.15 and 1.27, meaning that if a man had a DNA variant in these regions associated with high PSA he would be 15 to 27% more likely to have a negative biopsy result than men who did not.

The researchers then compared the presence of the six variations associated with higher PSA levels in men with and without prostate cancer. They found that four of the variations were also associated with a higher likelihood of prostate cancer. The other two variations were associated with higher PSA levels only.

The researchers then used various models to look at how adding a person’s genetic information might potentially improve the PSA test’s ability to distinguish between men with and without prostate cancer. They found that taking into account just the six variants they had linked to PSA levels improved the performance of the PSA test, but not by much. a model that combined an adjustment for genetic variations associated with high PSA levels and genetic variations associated with prostate cancer risk was the most accurate.

The researchers said that they have identified variations in six DNA regions associated with PSA levels. They said that, of the four models that they produced in order to predict biopsy outcome in men who had high PSA levels, the greatest improvement in prediction accuracy was seen when both the genetic factors associated with high PSA and with increased prostate cancer risk were taken into account.

They said that “for a screening test as important and as widely used as the PSA test, having a better way to interpret the measured serum PSA levels is likely to improve substantially the clinical usefulness of the test”.

This well-conducted research found that it is possible to increase the predictive power of the PSA test by taking into account genetic factors associated with higher levels of PSA and increased risk of prostate cancer. This is a useful step towards improving the performance of the PSA test for identifying prostate cancer. Use of the PSA test alone produces a high rate of false positive and false negative rates, leading to some men undergoing unnecessary biopsies and some cases of prostate cancer being undetected.

The researchers highlighted that they had based their analysis mostly on data from two populations, from Iceland and the UK, and further large prospective studies with mixed populations would be needed to see whether these findings could be applied generally.

Lastly, the models used in this study did not include other factors that may have influenced the results, such as age, ethnicity and family history of the disease. These too would ideally be tested for inclusion in a model aimed at improving how well the PSA test identifies prostate cancer in individuals.

Once they have been optimised, such models would need to be tested in clinical trials to determine whether they have the power to reduce deaths from prostate cancer.

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There are very few specific symptoms of prostate cancer. It usually grows so slowly that a man could die of something else before the cancer showed external symptoms. Difficulties with urination can be an indication of cancer, or it can just be benign hyperplasia (overgrowth) of the prostate.

More reliable indicators are calcium deposits or hardening in the prostate (to be found by a digital rectal exam) or a sharp rise in the serum level of Prostate Specific Antigen (PSA), done by a blood test. That's how I was diagnosed. I did have other symptoms, such as transient, sharp pain in the ribs, shoulders and other places, and an easily fractured rib, but that was due to metastasis, late in the game. the symptoms did not specifically indicate cancer.

If you are having chronic urination problems, or if you're over 45, you should probably get a DRE and a PSA test. Without those, you'll never know. If there are signs of cancer, a biopsy will be next. Depending on what is found, you may be facing surgery, irradiation, hormone suppression therapy or nothing at all. A slow-growing cancer may not need anything more than occasional monitoring. most prostate cancer patients die of something else. Surgery, radiation, hormone therapy or chemotherapy can greatly improve the odds of surviving aggressive cancers. but of course statistics are not individual people. Everyone has a different experience.

I was diagnosed with prostate cancer 18 months ago. I had no symptoms. my PSA kept rising and I had a biopsy which showed a small amount of Cancer. I was treated with radioactive seed implants and I am doing fine.

I expect to be around for many more years. I am 62.

Symptoms dont always tell what stage the cancer is in. Could still be very early.

If its early, its almost 100%

Even in stage 2 its very high, 95% or more.

Stage 3 gets dicey.

Yellow skin and eyes, stool that floats, are two of the symptoms. A co-worker looked very yellow and I noticed it for months but did not say anything, then we found out he had prostate cancer. Patrick Swayze in his book said that he noticed it because when he drank champagne it burned his stomach like he was drinking acid.

Survival rates are not good, I found this on line:

"Early stages
Even for those people diagnosed early, the outlook is not very good. If the cancer has not spread outside of the pancreas, and surgery is possible, then about 15 out of 100 people (15%) will be alive 5 years later. In those who do not live this long, it is likely that a small number of cancer cells have ‘escaped’ from the pancreas and travelled to other parts of the body. these cells are capable of growing into other tumours later.

Advanced stages
For people diagnosed with locally advanced disease, which cannot be removed by an operation, the average life expectancy is 6 to 11 months. for people whose cancer has already spread to another part of their body, the average life expectancy is only 2 to 6 months. but this can vary a lot depending on how much the cancer has grown and where it has spread."

Australian researchers undertook a five year study to investigate the extent and duration of one of the most common side-effects of prostate cancer treatment: impotence.

Transcript

This transcript was typed from a recording of the program. The ABC cannot guarantee its complete accuracy because of the possibility of mishearing and occasional difficulty in identifying speakers.

Norman Swan: good morning and welcome. Today on the Health Report a radical way of operating on your liver, what you and me as health consumers, not to mention doctors and nurses, might learn from the recent Qantas A380 emergency in Singapore and…

The results of a five-year follow-up of 2,000 Australian men who have been treated for prostate cancer to see what complications endure and how they’ve survived. and as you’ll hear, the findings are a bit troubling.

The person who coordinates this study is Dr David Smith, who presented the results at a cancer conference in Melbourne last week.

David Smith: most men are diagnosed with localised prostate cancer, that’s an early type of prostate cancer, so in our cohort we had 88% were diagnosed with localised prostate cancer, potentially curable and 63% of our men were diagnosed with no symptoms.

Norman Swan: They were diagnosed having had a PSA test?

David Smith: This is very much a group of men who represent men diagnosed as a result of PSA, yes.

Norman Swan: a year or so ago you published the three-year follow-up and now what you did this week at the Clinical Oncology Society of Australia meeting in Melbourne was actually look at the five-year follow-up of these men. So just take us through how they are going in terms of what many men are concerned about, with complications such as impotence and incontinence.

David Smith: what I presented this week was the men with localised prostate cancer and in general they are going pretty well. When you look at their overall quality of life they don’t differ in many respects from the control group that we studied, so that’s a normal group of men from the general population who don’t have prostate cancer. But in certain areas there are risks that are being attributable to the type of treatment they had. and the biggest risk that men who have prostate cancer treatment face is in sexual function. and the group that we looked at overall about 70% to 75% of men were impotent five years after the treatment for prostate cancer.

Norman Swan: Now there are degrees of erectile dysfunction; what are we talking about here?

David Smith: The single measure that we’ve used was whether men were able to achieve an erection sufficient for sexual intercourse.

Norman Swan: Without a drug?

David Smith: That includes with drugs.

Norman Swan: Right, so you could take a Viagra like drug?

David Smith: That’s correct. if you’ve had a drug or any other aid, a penile implant, or a vacuum erection device and you could get an erection, we include you as being potent.

Norman Swan: Now that’s probably higher than many urologists think it is?

David Smith: That is higher than most urologists think it is. we took our three-year results to a group of urologists and before we presented the results we said what do you think the impotence rates are? and they recorded levels quite a bit lower than our results, our population whole results.

Norman Swan: did it vary by surgeon or you didn’t analyse by surgeon?

David Smith: we haven’t analysed by surgeon, I think there are some good studies overseas that show that surgeon experience and volume are important but we haven’t analysed by surgeon.

Norman Swan: Does it vary by surgical procedures? So some surgeons do it with a robot, or say they try and spare the nerves around the prostate which might help erection to occur. When you had a nerve-sparing operation did that seem to make a difference, or what the surgeon claimed was a nerve sparing operation?

David Smith: The robots were not in great use at the time of our study. But the second part of that question is whether nerve sparing intent was offered compared with non-nerve sparing intent with radical prostatectomy. we found that nerve-sparing intent did improve sexual outcome but not greatly and men who had nerve-sparing intent were often the most disappointed when it didn’t work.

Norman Swan: So how does this marry with the fact that when you look at the psychological profile they didn’t vary from controls when they were having quite significant sexual dysfunction: three out of four of them?

David Smith: The measures we used to look at overall psychological wellbeing aren’t specific enough to pick out the fine details that affect a man’s sexual life.

Norman Swan: Men are offered more than just surgery if they’ve got prostate cancer. They could be offered radio therapy, two forms of radio therapy — one is where you get the machine aimed at your prostate gland and the other is where they put radioactive seeds inside the prostate: so-called brachytherapy, which is claimed to have a lower rate of sexual dysfunction although it causes other problems as well, such as irritation in the bowel and the bladder. what did you find there?

David Smith: we looked at external beam radio therapy and we looked at whether men had androgen deprivation therapy as well and we also looked at high dose rate and low dose rate of brachytherapy. by five years the men on low dose rate brachytherapy had almost returned to a normal control group sexual functioning. So low dose rate brachytherapy in our group certainly showed the best sexual outcomes at five years.

Norman Swan: and of course the one issue with low dose rate brachytherapy is that it’s yet to be shown to perform as well as surgery in terms of survival and recurrence.

David Smith: That’s right.

Norman Swan: Incontinence?

David Smith: Incontinence is a lower level of risk in the group that we looked at but in radical prostatectomy there were about 12% of men who had persistent incontinence.

Norman Swan: and the predictors of erectile function after surgery, are they the same as people have said that if you were strongly potent before, you stand to be in the one in four who are going to have it afterwards?

David Smith: Men who are younger certainly had much better potency than the older men in our group. Men with good baseline sexual function had better sexual function at five years. Men with less co-morbidities, so other diseases that might affect sexual function…

Norman Swan: Like heart disease or diabetes?

David Smith: Absolutely, but also some interesting socio-economic issues, so men from regional and rural parts of Australia had worse sexual function and men with lower incomes had worse sexual function.

Norman Swan: how do you explain that?

David Smith: I think it’s an issue about access to large centres, perhaps private health insurance as well.

Norman Swan: So you’re suggesting less experienced urologists are operating on them?

David Smith: That could be the case.

Norman Swan: The other issue with rural people from data from the Cancer Institute of NSW is that they get diagnosed later. did rural men in your sample have less localised cancer?

David Smith: yes, there was a small but significant difference in the stage of presentation in our group.

Norman Swan: So what are the immediate implications of your findings? Presumably informed consent needs to change a little bit.

David Smith: we think that better communication is needed in the consultation about when men are deciding the type of treatment for prostate cancer. The group of men when asked stated that they would have liked to have a bit more time to consider the type of treatment that they had and they would have liked to have had more information about the likely consequences. So we think that’s the initial priority.

Norman Swan: and to be fair to Australian urologists, or at least the ones who specialise in this kind of surgery, they are found to say to people ‘look, you’ve got time, this is not necessarily something you’ve got to decide tomorrow’.

David Smith: Absolutely. and I think there’s a growing feeling now that active surveillance which is a wait and see approach and not hopping straight in and treating prostate cancer radically is a very good alternative for men with the right type of disease which gives them time to think about the best way to treat it in the long term.

Norman Swan: Given this was done in NSW you think the results are applicable elsewhere in Australia, much less internationally?

David Smith: there are subtle differences between the states in the way in which treatment is offered. some differences that we’ve seen in terms of survival may be partly a result of…

Norman Swan: oh spit it out, what are you actually trying to say David?

David Smith: Look we know that in some of the smaller states, there are only a few urologists and they treat prostate cancer differently from some other areas. So there are lots of regional differences.

Norman Swan: what you’re trying to say here is that in smaller states the skill level might not be up to scratch?

David Smith: oh no, not at all, I think…

Norman Swan: So there’s a smaller number of urologists doing all the work therefore they are getting quite good at it?

David Smith: That could well be the case and the problem is there is no other data like this in Australia, let alone in the world, this is one of the few studies that has got a large group of men with prostate cancer from the whole population not just from one centre of excellence and also has a control group to compare them with across all the treatment types.

Norman Swan: So this data are not a reason for not having the operation it’s just have the information at hand when you make the decision?

David Smith: Absolutely, talk to your doctor about the best options for you and if you’re not happy with what you’re being offered by the first doctor you go and see ask for a referral.

Norman Swan: Dr David Smith is a research fellow at the Cancer Council of NSW and you’re listening to the Health Report with me Norman Swan here on ABC Radio National.

Smith DP et al. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. British Medical Journal 2009 Nov 27;339:b4817.doi:10.1136/bmj.b4817