Prostate Cancer Awareness Guide: Symptoms, Risk, Prevention, Detection and Screening Age

Prostate cancer is one of the most common cancers in men. In its early stages it usually causes no symptoms at all, so you can feel completely well and still have it. That is why it is important to know your risk and to talk to a doctor about a PSA blood test.

If you have concerns about your prostate, urinary symptoms or your personal risk of prostate cancer, book a consultation with a Lenmed healthcare professional to discuss your concerns and whether screening is appropriate for you.

Key points at a glance
Early prostate cancer usually has no symptoms.
A simple blood test (PSA) can pick up early warning signs.
Most men should talk to a doctor about PSA testing from age 50. Start at 45 if you are a man of African descent or prostate cancer runs in your family, and at 40 if you carry the BRCA2 gene change.
A raised PSA does not mean you have cancer. It means you need further checks, usually by a urologist.
When found early, most prostate cancers can be cured or safely monitored.

What Is Prostate Cancer and Who Is Affected?

The prostate is a small gland in the male reproductive system. It sits below the bladder and surrounds part of the urethra, the tube that carries urine out of the body. The prostate produces fluid that forms part of semen.

Prostate cancer develops when cells in the prostate begin to grow abnormally. Some prostate cancers grow slowly and may never cause significant problems, while others can be more aggressive and spread beyond the prostate if they are not detected and treated.

Age is one of the most important factors affecting prostate cancer risk. The likelihood of developing the disease increases as men get older, particularly from around the age of 50. Family history and African ancestry are also important considerations when assessing an individual’s risk.

Prostate cancer awareness is therefore not only about recognising symptoms. It is also about understanding your risk before symptoms appear.

Prostate Cancer Symptoms: What To Look Out For

One of the most important things to know about prostate cancer is that early-stage disease often has no symptoms. Waiting for warning signs is therefore not a reliable approach to prostate cancer detection.

When symptoms do occur, they may include:

Frequent urination, particularly at night
Difficulty starting or stopping urination
A weak or interrupted urine stream
Difficulty emptying the bladder
Pain or burning when urinating
Pain during ejaculation
Blood in the urine or semen
Bone pain, or pain in the lower back, hips or pelvis that does not go away (usually in more advanced disease)
Unexplained weight loss or tiredness (usually in more advanced disease)

These symptoms do not automatically mean prostate cancer. Most of the time they are caused by more common, non-cancerous prostate or bladder problems. But they should always be checked by a doctor.

BPH, Infection and Prostate Cancer Symptoms

Benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate, becomes more common with age. Because the prostate surrounds part of the urethra, enlargement can affect the flow of urine and cause symptoms such as frequent urination, a weak stream or difficulty emptying the bladder.

Prostatitis, or inflammation of the prostate, and urinary tract infections can also cause urinary symptoms and may affect PSA levels.

This is why symptoms alone cannot confirm or rule out prostate cancer. A healthcare professional can assess your symptoms, medical history and risk factors and decide which tests are needed, and refer you to a urologist if necessary.

Prostate Cancer Risk Factors for Southern African Men

Understanding prostate cancer risk can help you make informed decisions about screening and healthcare.

Important risk factors include:

Age: The risk of prostate cancer increases as men get older, with the disease being uncommon in younger men.

African ancestry: Men of African ancestry have a higher risk of prostate cancer and are more likely to develop aggressive disease, often at a younger age. For this reason, Black men are advised to start talking to their doctor about PSA testing earlier, from age 45.

Family history: Your risk is higher if your father or brother has had prostate cancer, especially if they were diagnosed at a young age, or if several relatives on the same side of the family have had prostate, breast or ovarian cancer. Some families carry inherited gene changes, such as BRCA2 or BRCA1, that raise the risk. If this applies to you, tell your doctor: you may need to start testing earlier and may benefit from genetic counselling.

Other health and lifestyle factors: Research has identified associations between prostate cancer risk and factors including excess body weight, physical inactivity and some dietary patterns. However, having a risk factor does not mean that you will develop prostate cancer.

Your personal risk is best considered alongside your age, family history, ancestry and overall health rather than by looking at any one factor in isolation.

Prostate Cancer Screening: The PSA Test and Prostate Exam Explained

Prostate cancer screening is used to look for signs of cancer before symptoms develop. The most commonly discussed screening test is the prostate-specific antigen (PSA) blood test.

PSA is a protein produced by cells in the prostate. A blood test measures the amount of PSA in your blood. A raised PSA level can occur with prostate cancer, but it can also be caused by non-cancerous conditions such as BPH or inflammation and infection of the prostate.

This means a PSA test is not a cancer diagnosis. An abnormal result may simply mean that further assessment is needed.

Getting an accurate PSA result
Avoid ejaculation and long or hard cycling for 48 hours before the test, as these can raise PSA for a short time.
Do not have the test while you have a urine infection. Wait until it has been treated and cleared, as infection can raise PSA for several weeks.
Tell your doctor if you take finasteride or dutasteride (tablets for an enlarged prostate or hair loss). These lower PSA by about half, so your result needs to be adjusted.
A recent urinary catheter or procedure on the bladder or prostate can also raise PSA.

Your doctor may also do a digital rectal examination (DRE). During this quick clinical exam, a gloved finger is used to feel the prostate through the rectum for abnormalities such as an unusual lump or firmness.

A DRE is not used on its own as a screening test, because it can miss early cancers. It is most useful together with a PSA test, especially if your PSA is raised.

Although the idea of a prostate examination can feel uncomfortable or embarrassing, it is a routine clinical assessment. Talking openly about men’s health can make it easier to identify potential problems before they become more difficult to manage.

Prostate Cancer Screening Age: When Should You Start?

There is no single prostate cancer screening age that applies to every man.

In South Africa, CANSA advises men to discuss prostate cancer screening with a healthcare professional, generally from age 50 and earlier for those at increased risk. Its published guidance also identifies Black men and men with a family history of prostate cancer as higher-risk groups. The recommended age for starting screening varies between guidelines, so men should discuss their individual risk factors and the potential benefits and risks of PSA testing with a healthcare professional.

The European Association of Urology (EAU) guidelines recommend offering PSA testing to well-informed men, after a discussion of the benefits and risks, who are expected to live for at least another 10 to 15 years:
From age 50: men at average risk
From age 45: men with a family history of prostate cancer, and men of African descent
From age 40: men who carry a BRCA2 gene change

How often should I be tested? This depends on your first PSA result and your risk. If your PSA is very low, the test may only need repeating every few years. If it is higher, your doctor will suggest testing more often.

Are there downsides to testing? Testing can find cancer early, when it is easier to treat. It can also find slow-growing cancers that would never have caused harm, which may lead to extra tests or treatment you did not need. For older men, or men with other serious illnesses, the benefit of testing becomes smaller. Talking this through with your doctor helps you decide what is right for you.

The right approach depends on your individual circumstances. Your healthcare professional can discuss the potential benefits and limitations of screening and help you decide whether PSA testing is appropriate.

Screening is also not the same as having symptoms investigated. If you have urinary changes, blood in your urine or semen, persistent pelvic or back pain or another concerning symptom, see your doctor promptly, whatever your age.

Prostate Cancer Detection: What Happens After an Abnormal Result?

An abnormal PSA result does not mean you have prostate cancer. Many men with a raised PSA turn out not to have cancer. It does mean you should see a urologist.

PSA can be affected by several non-cancerous conditions and other factors. A urologist will look at your result together with your symptoms, medical history and risk factors and advise you on whether any further tests are needed.

A diagnosis of prostate cancer can only be confirmed with a prostate biopsy, not by a PSA result alone.

The important point is that an abnormal screening result is the beginning of an investigation, not a diagnosis. The best next step is to consult a urologist.

Lifestyle Tips: Can Prostate Cancer Be Prevented?

There is no guaranteed way to prevent prostate cancer, and some of the strongest risk factors, including age, ancestry and family history, cannot be changed.

However, looking after your overall health can help reduce the risk of cancer and other chronic conditions. Practical steps include:

Maintaining a healthy weight
Staying physically active
Eating a balanced diet with plenty of vegetables, fruit, wholegrains and other nutrient-rich foods
Limiting foods high in saturated fat and highly-processed foods
Avoiding smoking
Limiting excessive alcohol consumption
Keeping up with routine healthcare appointments

No vitamin, supplement or medicine has been proven to prevent prostate cancer. A healthy lifestyle is not a substitute for testing or medical assessment. Even men who live a healthy lifestyle can develop prostate cancer, so knowing your personal risk and discussing appropriate screening remains important.

When Should You See a Urologist?

Your GP or family doctor can do your first PSA test. You should be referred to a urologist (a specialist in prostate, bladder and kidney problems) if:

Your PSA is higher than expected for your age, or keeps rising on repeat tests
Your doctor feels a lump or hard area on your prostate
You see blood in your urine, even once and even if it is painless
You have a strong family history of prostate, breast or ovarian cancer or a known BRCA gene change
Your urinary symptoms are bothering you or are not improving with treatment
You have bone pain or unexplained weight loss together with urinary changes

Get help urgently if you cannot pass urine at all, or if you suddenly develop weakness or numbness in your legs or lose control of your bladder or bowels.

Tip: Take any previous PSA results and a list of your medicines to your appointment. Earlier results help the urologist see whether your PSA is changing over time.

Prostate Cancer Care and Next Steps with Lenmed

Prostate health does not need to be a difficult or embarrassing subject. Whether you are approaching the recommended screening age, have a family history of prostate cancer or have noticed a change in your urinary or sexual health, speaking to a healthcare professional is a practical first step.

Lenmed hospitals across Southern Africa provide access to healthcare professionals and specialist services, including urology and cancer-related care at selected facilities. Lenmed’s network includes hospitals in South Africa, Botswana and Mozambique.

For example, Lenmed has urologists with interests in prostate disease, prostate cancer and men’s health at facilities including Ahmed Kathrada Private Hospital, Howick Private Hospital, La Verna Private Hospital and Ethekwini Hospital and Heart Centre.

Concerned about your prostate health? Book a consultation with a Lenmed healthcare professional to discuss your symptoms, risk factors and whether prostate cancer screening is right for you.

The earlier a potential problem is investigated, the sooner you can understand what is happening and discuss the appropriate care or treatment.

Frequently Asked Questions

What are the first symptoms of prostate cancer?
Early prostate cancer often has no symptoms. When symptoms occur, they can include frequent urination, difficulty starting urination, a weak or interrupted urine stream, blood in the urine or semen and other urinary or sexual changes. These symptoms can also have non-cancerous causes, so medical assessment is important.

Can you have prostate cancer without symptoms?
Yes. Early-stage prostate cancer often does not cause noticeable symptoms. This is one reason why understanding your risk and discussing prostate cancer screening with a healthcare professional can be important.

What is the prostate cancer screening age?
For most men, from age 50. European (EAU) guidance advises starting at 45 if you are of African descent or have a family history of prostate cancer, and at 40 if you carry a BRCA2 gene change. South African guidance suggests starting the conversation from around 45, or from 40 if you are at higher risk. Your doctor can advise what is right for you.

Is a PSA test enough to detect prostate cancer?
No. PSA testing can help identify prostate abnormalities, but an elevated PSA does not necessarily mean cancer. Benign prostatic hyperplasia (BPH), infection and inflammation can also raise PSA levels. If your PSA is raised, consult a urologist, who will advise you on the next steps.

Does an enlarged prostate mean I have prostate cancer?
No. Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate and is common as men get older. However, BPH and prostate cancer can cause similar urinary symptoms, so persistent or concerning symptoms should be assessed by a healthcare professional.

Who is at higher risk of prostate cancer?
Risk increases with age and is higher among men of African ancestry and those with a family history of prostate cancer. Certain inherited gene changes, including BRCA2 mutations, can also increase risk.

Can prostate cancer be prevented?
There is no guaranteed way to prevent prostate cancer. Maintaining a healthy weight, being physically active, eating a balanced diet, avoiding smoking and limiting excessive alcohol can support overall health and may help reduce cancer risk.

Is prostate cancer treatable if it is detected early?
Many prostate cancers can be managed effectively, particularly when they are found before they have spread. Treatment depends on factors such as the cancer’s stage and grade, the individual’s health and preferences and how quickly the cancer is growing. Options include active surveillance (careful monitoring of low-risk cancer with regular PSA tests, MRI scans and sometimes biopsies, so that treatment is only given if needed), surgery and radiotherapy. Hormone therapy and other medicines are mainly used for more advanced cancer.

If you are concerned about prostate cancer or your prostate health, don’t wait for symptoms to become severe. Book a consultation with a Lenmed urologist or a Lenmed general practitioner or family physician to discuss your risk, screening options and any changes you have noticed.

For more information, please contact:

Dr NT Nkosi
Discipline: Urologist
Hospital: La Verna Private Hospital
Telephone: +27 (0) 36 637 2224
Email: ntnkosi9188@gmail.com

And

Name: Dr M Kolia
Discipline: Urologist
Hospital: Royal Hospital and Heart Centre
Telephone: +27 (0) 53 045 0476

And

Dr SP Sadhwani
Discipline: Urologist
Hospital: Howick Private Hospital
Telephone: 033 0155109
Email: drsanjaysadhwani@gmail.com