PROSTATE CANCER CLINICAL PRESENTATION

Prostate cancer: clinical presentation
Since the widespread use of serum PSA testing, the majority of patients have non-metastatic disease at presentation. Shown below are the possible presentations, grouped by disease stage.

Localized prostate cancer (T1 - 2)
- Asymptomatic, with screening serum PSA or incidental digital rectal examination (DRE)
- Lower urinary tract symptoms (probably due to coexisting benign hyperplasia causing bladder outflow obstruction)
- Haematospermia
- Haematuria (probably due to coexisting benign hyperplasia)
- Perineal discomfort (probably due to coexisting prostatitis)

Locally advanced cancer (T3 - 4)
- Asymptomatic, with screening serum PSA or incidental DRE
- Lower urinary tract symptoms
- Haematospermia
- Haematuria
- Perineal discomfort
- Symptoms of renal failure/anuria due to ureteric obstruction
- Malignant priapism (rare)
- Rectal obstruction (rare)

Metastatic disease (N+, M+)
- Asymptomatic ( occult disease ), with screening serum PSA or incidental DRE
- Swelling of lower limb due to lymphatic obstruction
- Anorexia, weight loss
- Bone pain, pathological fracture
- Neurological symptoms/signs in lower limbs (spinal cord compression)
- Anaemia
- Dyspnoea, jaundice, bleeding tendency (coagulopathy)