Prostate Cancer: Early Stages Often Asymptomatic, Diagnosis Delayed Until Urination Issues or Bone Pain Appear

Prostate cancer frequently progresses without noticeable symptoms in its early stages, leading many individuals to discover their condition only when facing issues like difficulty urinating or experiencing bone pain. This delayed diagnosis can significantly impact treatment outcomes.

A case highlighted by Dr. Gu Fang-yu, president of Gu Jia Medical, involved a 62-year-old factory owner who had suffered from chronic back pain for years, with orthopedic treatments proving ineffective. His condition came to light when he sought medical attention for urinary problems. Tests revealed his prostate-specific antigen (PSA) level was elevated, prompting further investigation with a high-resolution prostate MRI. This examination strongly suggested prostate cancer, which was later confirmed to have metastasized to his entire spine, classifying it as stage 4.

Dr. Gu explained that prostate cancer typically develops slowly and often presents no symptoms initially. Even when symptoms like frequent urination or a weaker stream appear, they are often mistaken for age-related changes or benign prostatic hyperplasia, causing patients to miss the opportunity for early diagnosis. The patient's PSA level of 10-11 was considered a "gray area," slightly above the normal reference range. The MRI successfully identified suspicious lesions, leading to the referral and subsequent diagnosis.

While PSA testing is a common screening tool, its accuracy can be affected by conditions like benign prostatic hyperplasia or inflammation. More precise methods, such as the PHI (Prostate Health Index) blood test, which analyzes different PSA protein subtypes, can help estimate the risk of prostate cancer. High-resolution prostate MRI can further aid in identifying suspicious areas and guiding decisions about biopsies, improving diagnostic accuracy and reducing the chance of missed diagnoses.

Dr. Gu emphasized that early detection is key to successfully treating prostate cancer. Stage 1 and 2 cancers have a high cure rate with timely treatment. However, if the cancer has spread to the bones, lymph nodes, or other organs, treatment becomes more challenging, and the five-year survival rate can drop significantly. Bone metastasis, a common occurrence in prostate cancer, can manifest as persistent back or pelvic pain, often misattributed to musculoskeletal issues, thus delaying diagnosis. With Taiwan's Ministry of Health and Welfare planning a pilot screening program for prostate cancer in 2027, Dr. Gu advises men aged 50 and above, or those aged 45 and above with a family history or BRCA gene mutations, to undergo regular check-ups. Abnormal PSA results should prompt a specialist evaluation, potentially including PHI or high-resolution MRI, to ensure timely diagnosis and optimal treatment.