No Symptoms Doesn't Mean You're Safe — That's Why Prostate Cancer is So Dangerous

[00:00:00]What are the symptoms of prostate cancer? That is genuinely the wrong question. And I say that as a urologist who has diagnosed this disease in men who felt completely normal the morning they sit down with me in the office.

[00:00:14]Here's the number that should concern every man watching this. Approximately 70% of men diagnosed with early stage prostate cancer had no urinary symptoms whatsoever at the time of diagnosis.

[00:00:29]none. The most common cancer in Australian men and it gives you almost no warning. So, in the next eight minutes, I'm going to give you a list of symptoms to watch for. I'm going to explain why this cancer is biologically silent, exactly what does detect it, and which men can't afford to wait before getting tested. For those of you new to the channel, I'm associate professor Charles Shabir. I'm a urologist and director of the prostate clinic located here on the Gold Coast. As always, if you get benefit, please thumbs up to the video and subscribe to the channel for more content like this. Now, here's what we're covering. Why prostate cancer produces no symptoms in its early stage and why that's not a flaw in medicine.

[00:01:16]It's a flaw in how men think about screening. Now, what actually detects it before it spreads? how to find out right now whether you are in the window where testing matters most and the three situations where symptoms can appear which I'll get to at around about the 5 minute mark because that's important context too. Now the prostate sits deep in the pelvis. It's wrapped around the urethra. It's shaped like a donut and the tube that carries urine out of the body passes through the middle. The prostate is roughly the size of a walnut. Early prostate cancer almost always starts in the outer zone of the gland. The outer zone is far away from the urethra or the tube and therefore a small tumor growing there growing over 2 or 3 years. It actually doesn't cause any compression of the pipe and therefore doesn't obstruct the flow. It doesn't cause pain and it doesn't cause bleeding. Now, this is why the wait for symptoms approach really is so dangerous. By the time that cancer causes urinary symptoms, it's often already grown large enough or spread far enough that the treatment options become limited. The symptoms are not missing because the disease isn't there. They're missing because the disease is somewhere where your body can't feel it. So, if you can't feel it, what finds it? Well, there's two things. Number one, a PSA blood test and also an examination of the prostate performed by your urologist or your GP. Now, a PSA or prostatic specific antigen is a protein the prostate produces. As cancer cells grow, they leak more PSA into the bloodstream.

[00:03:07]Now, the test does not diagnose cancer, but it flags something that needs further investigation. I've covered PSA in detail in a dedicated video. I'll I'll leave the link in the description below. Now, here's what I want to stop and make this personal. So, stop right now. Before I continue, I want you to answer three questions. And you can do this in your head in the next 20 seconds. Number one, are you over the age of 50 or older? Do you have a father or a brother or a son perhaps who's been diagnosed with prostate cancer? Number three, do you have African or Caribbean ancestry? Now, if you answered yes to any of these three questions, you're in the group where testing is not optional.

[00:03:57]It's overdue. Screenshot this card.

[00:04:00]These are the three triggers that should have already prompted a conversation with your GP. The men I see presenting with advanced disease are almost never men who had no risk factors. They're men who had risk factors and no one told them those risk factors meant they needed to act. Okay. Now, when should we start testing? Well, for the average risk man, no family history, no high-risisk ancestry, most guidelines recommend a PSA test beginning at 50.

[00:04:33]For those men who have a firstderee relative diagnosed with prostate cancer, the window moves to the mid to early 40s. For those men with two or more effective relatives, or if you've got Bracka 2 mutations in the family, the conversation needs to start at 40. Now the reason this window matters PSA monitoring over time gives us a baseline. A reading of 2.1 that was for example 1.4 2 years ago tells me a very different story from a standalone PSA of 2.1. What I mean is the trend is the signal. Now you cannot get a trend from a single blood test on its own if you start at 65. Now your GP orders a PSA test. It comes back elevated. What happens next? Well, step one, repeat the test. One elevated result is not a diagnosis. Inflammation, recent physical activity, sexual activity in the prior 48 hours can push the value up. Step two is repeat the PSA with a free to total ratio. This refineses the picture and makes the PSA test more specific. Step number three is if we still have an elevated PSA, the next step is a multiparametric MRI. Now, almost always, and certainly at the prostate clinic for the last 15 years or so, an MRI almost always precedes a biopsy. It tells us if there's a target lesion and where it is, and it certainly avoids unnecessary biopsies in a significant proportion of men. Biopsy, if indicated, is the step after an MRI, not the first step. Now, I promise you I'd cover three situations where symptoms can appear. This is the context I want you to hold on to carefully. Number one, advanced local disease. So when a tumor has grown large enough to involve the urethra or potentially extend into the bladder, urinary symptoms, often difficulty starting a flow, a weak stream, frequency can emerge. But this typically means that the cancer has been present and growing for a significant period of time. Now number two, bone metastasis.

[00:07:01]So when the prostate cancer spreads to bones most commonly to the spine, the pelvis, the hips, it can cause pain. It can cause back pain or hip pain, rib pain that won't resolve. Now if someone has persistent unexplained bone pain, it warrants further investigation. Number three is spinal cord compression. Now a rare but urgent presentation is where there is leg weakness, some numbness or bladder or bowel dysfunction. This is a medical emergency. Now again, I'm not telling you this to frighten you. I'm telling you this because I want every man watching this to understand that prostate cancer gives you a symptom and the window for the best outcome may have already narrowed. Risk factors that mean you cannot wait. Number one, 50 or older, father, brother, son with prostate cancer, African or Caribbean ancestry, known Bracka 1 or BA 2, Lynch syndrome, or another hereditary cancer syndrome. If you've got one or more of these and they apply to you, you need to have the PSA conversation with your GP.

[00:08:16]You should have had it already. If you haven't, that conversation needs to happen this week. So, five questions I want you to take to your next appointment with your GP. Number one, based on your age, your family history, when should you start having a PSA test?

[00:08:35]Number two, do I have a baseline PSA on file and what is the trend? Number three, what is my free to total PSA ratio? Number four, do any of the five high- risk factors apply to me? Number five, if my PSA is elevated, what's the next step and should I see a urologist?

[00:08:58]Print that list out. Take it with you.

[00:09:01]Again, this information could genuinely save your life. If you've never had a PSA test, the next step is simple. Talk to your GP this week about having a PSA test. If you've had one, watch my PSA levels by age video. I'll leave the link in description. If you want to know more about your prostate, have a look at this video or alternatively this video here.