Men with prostate cancer generally have no symptoms, especially in the earliest stages. This is why screening is so important.

For some men, symptoms include:

• Frequent urination, especially at night
• Weak urinary stream
• Difficulty starting or stopping the flow of urine
• Pain or a burning sensation when urinating
• Blood in the urine
• Pain or stiffness in the lower back, hips or thighs
• Pain during sex

Testing for prostate cancer

Detecting prostate cancer usually involves a series of steps. Your doctor will first ask you about your medical history and any symptoms you're having

Next, your doctor will most likely perform a digital rectal examination (DRE) by inserting a gloved, lubricated finger into the rectum to feel the size and texture of your prostate.

A prostate specific antigen (PSA) test, used in addition to DRE, increases the likelihood of cancer detection. A PSA test measures the level of prostate specific antigen, a substance produced mainly by the prostate cells in the bloodstream. A high level of PSA in the bloodstream can be a warning sign that prostate cancer may be present.

The results of either or both tests (DRE and PSA) may suggest the need for an ultrasound and a biopsy. Only a biopsy can definitively confirm the presence of prostate cancer.

About PSA

PSA is a chemical that is produced by prostate cells, both normal and cancerous. Other cells in the body do not produce significant amounts of PSA. Normally, only a small amount of PSA gets into the bloodstream. However, when the prostate is irritated, inflamed or damaged, PSA leaks into the bloodstream more easily. This causes the level of PSA in the blood to be higher.

The normal range for PSA is usually between 0 and 4. Some doctors believe that the normal range for the PSA varies with age and race.

Once a normal, baseline PSA has been obtained, the number becomes less important and the rate of change of the PSA over time becomes more important.

What if I have cancer?

Hearing that you have cancer can be very scary. We understand your fears and concerns. Through the HealthEast Prostate Care program, you will receive personalized care. A care coordinator partners with you and guides you and your family to the specialists, technology and services you need.

Questions to ask your doctor

It's important to work with your doctor to learn about your options. Write down your questions and bring them to your doctor's visit or ask if you can bring a tape recorder to your appointment. It may also be reassuring to have a family member or friend in the examining room with you to serve as another set of ears.

You may want to ask your doctor:

• What are my treatment options?
• What are the expected benefits and prognosis of each treatment?
• What are the risks and possible side effects of each treatment?
• What are my chances of being cured?
• What might happen if I choose not to have treatment?
• Would a clinical trial be appropriate for me?
• How will my day-to-day activity level change with each kind of treatment?
• What is the follow-up care for each treatment?
• What are my chances of becoming incontinent?
• How will the various treatment options affect my sex life?
• When can I start to exercise?
• When will I be able to return to work?

If your doctor recommends surgery, you may want to ask:

• Is this surgery really necessary?
• Are there other less costly or less risky alternatives?
• How many of these operations have you performed?
• If I have this surgery, how long will it take for me to recover?
• Could I delay the surgery and try some other form of treatment first?
• Will you personally do the operation or will you be part of a surgical team?