Symptoms of early-stage prostate cancer
Screening with the prostate-specific antigen (PSA) test can detect early-stage prostate cancer while it's still asymptomatic.
使用前列腺特异性抗原 (PSA) 测试进行筛查可以检测出无症状的早期前列腺癌。
But some men are diagnosed with prostate cancer only after symptoms appear.
但有些男性只有在症状出现后才被诊断出患有前列腺癌。
For insights into how doctors distinguish prostate cancer from other noncancerous problems affecting the prostate, we turned to Dr. Marc B.
为了深入了解医生如何区分前列腺癌和影响前列腺的其他非癌性问题，我们向 Marc B.
Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases .
加尼克是哈佛医学院和贝斯以色列女执事医疗中心的戈尔曼兄弟医学教授，也是哈佛医学院前列腺疾病指南的主编。
I first want to mention that most men who are diagnosed with prostate cancer - including many with advanced forms of the disease - do not present with symptoms.
我首先想提的是，大多数被诊断患有前列腺癌的男性——包括许多患有该疾病的晚期——并没有出现任何症状。
When symptoms do appear in a man with early-stage disease, they affect his ability to urinate.
当患有早期疾病的男性确实出现症状时，它们会影响他的排尿能力。
Lower urinary tract symptoms (LUTS), as we call them, include urinary frequency, urgency, difficulty starting or stopping a stream, getting up repeatedly at night to pee, or feeling like you're never able to fully empty your bladder.
我们所说的下尿路症状 (LUTS) 包括尿频、尿急、尿流开始或停止困难、夜间反复起床撒尿，或者感觉永远无法完全排空膀胱。
LUTS can develop if a tumor grows large enough to physically obstruct the urethra, which is the tube that carries urine out of the body.
如果肿瘤长到足以阻塞尿道（将尿液排出体外的管道），就会出现下尿路症状。
The diseased prostate can also push up against the bladder, thereby lessening its capacity to hold fluid.
患病的前列腺还会压迫膀胱，从而降低其容纳液体的能力。
But more often than not, urinary symptoms result from other problems with the prostate.
但泌尿系统症状通常是由前列腺的其他问题引起的。
Benign prostatic hyperplasia (BPH), for instance, is a natural enlargement of the prostate that affects most men as they get older.
例如，良性前列腺增生 (BPH) 是前列腺的自然增大，随着年龄的增长，会影响大多数男性。
Some men develop LUTS if the prostate and surrounding tissues become inflamed; this is called prostatitis.
如果前列腺和周围组织发炎，一些男性会出现 LUTS；这称为前列腺炎。
And if a man experiences burning sensations while urinating, then he likely has a problem with his bladder, not his prostate.
如果一个男人在小便时感到烧灼感，那么他的膀胱可能有问题，而不是前列腺有问题。
Men who experience any of these urinary symptoms should be evaluated by a doctor.
出现任何这些泌尿系统症状的男性应该由医生进行评估。
Assuming prostatitis and bladder disease have been ruled out, the next step is to differentiate between prostate cancer and BPH.
假设前列腺炎和膀胱疾病已被排除，下一步是区分前列腺癌和良性前列腺增生。
Men with BPH typically have two kinds of urinary symptoms.
患有 BPH 的男性通常有两种泌尿系统症状。
A red flag for prostate cancer would be having storage symptoms only, or urinary symptoms that develop very rapidly.
前列腺癌的危险信号是仅出现储存症状，或迅速发展的泌尿系统症状。
That would be unusual for LUTS caused by BPH.
这对于 BPH 引起的 LUTS 来说是不寻常的。
These symptoms can be assessed by having men fill out a questionnaire called American Urological Association Symptom Score .
这些症状可以通过让男性填写一份名为美国泌尿协会症状评分的调查问卷来评估。
The doctor can also do a digital rectal examination (DRE).
医生还可以进行直肠指检（DRE）。
If the prostate feels symmetrically enlarged - meaning the gland is bigger but in a uniform and evenly distributed way - then that helps to establish a BPH diagnosis.
如果感觉前列腺对称增大（意味着腺体更大，但分布均匀），则有助于诊断 BPH。
If there's asymmetry in the gland, or if the doctor feels a hard nodule, then the patient needs to be referred to a urologist for further evaluation.
如果腺体不对称，或者医生感觉到硬结节，则需要将患者转诊给泌尿科医生进行进一步评估。
DREs are performed less often now than they used to be, and many doctors have no training in the procedure.
现在进行 DRE 的次数比以前少了，而且许多医生没有接受过该手术的培训。
That's unfortunate, since in my view a DRE is one of the most important components of a physical examination.
这很不幸，因为在我看来，DRE 是体检最重要的组成部分之一。
Another thing people need to recognize is that BPH can eventually lead to kidney failure, or to a medical emergency called acute urinary retention, which is a sudden inability to urinate at all.
人们需要认识到的另一件事是，前列腺增生症最终会导致肾衰竭，或导致称为急性尿潴留的医疗紧急情况，即突然完全无法排尿。
So, BPH should really be treated to avoid these serious complications.
因此，前列腺增生症确实应该得到治疗，以避免这些严重的并发症。
It can.
可以。
PSA levels rise in men with BPH as they also do in men prostate cancer, simply because a larger, more irritated prostate gland releases more PSA into blood than a normal prostate does.
患有 BPH 的男性 PSA 水平升高，就像男性前列腺癌的情况一样，仅仅是因为更大、更易受刺激的前列腺会比正常前列腺释放更多的 PSA 到血液中。
Usually, we start patients on BPH drugs that can make it easier to urinate while also lowering PSA.
通常，我们开始为患者服用 BPH 药物，这些药物可以使排尿更容易，同时还能降低 PSA。
Then after six weeks or so, we test the PSA again.
然后大约六周后，我们再次测试 PSA。
If the levels come back high, then the next step is typically a magnetic resonance imaging (MRI) scan of the prostate.
如果水平恢复较高，那么下一步通常是对前列腺进行磁共振成像 (MRI) 扫描。
If the MRI is normal and the PSA is proportionate to the size of the prostate, then that helps to rule out cancer.
如果 MRI 正常且 PSA 与前列腺大小成比例，则有助于排除癌症。
In such cases, we can consider avoiding a prostate biopsy - at least temporarily - and continue to monitor PSA instead.
在这种情况下，我们可以考虑避免进行前列腺活检——至少暂时避免——而继续监测 PSA。
Even with advanced prostate cancer, many patients are still completely asymptomatic.
即使患有晚期前列腺癌，许多患者仍然完全无症状。
Fortunately, we've gotten much better at treating advanced disease, especially now that we have better scans to identify small deposits of cancer and methods to eliminate them.
幸运的是，我们在治疗晚期疾病方面已经取得了很大进步，特别是现在我们有了更好的扫描技术来识别微小的癌症沉积物以及消除它们的方法。
When symptoms do appear, especially if the cancer has spread to the bones, men typically show up with back or shoulder pain - basically pain where metastases grow near bone surfaces where nerves are located.
当症状确实出现时，特别是当癌症已经扩散到骨骼时，男性通常会出现背部或肩部疼痛——基本上是转移瘤在神经所在的骨表面附近生长时出现的疼痛。
Men who present with persistent back pain that's getting worse despite treatment interventions should be considered for further evaluations such as x-ray or MRI.
对于尽管接受治疗干预但仍出现持续性背痛且病情恶化的男性，应考虑进行进一步的评估，例如 X 射线或 MRI。
These sorts of symptoms are more common in other cancers such as colon cancer, lung cancer, and lymphoma.
此类症状在结肠癌、肺癌和淋巴瘤等其他癌症中更为常见。
You typically don't see them in prostate cancer unless the cancer is very advanced with widespread metastases.
通常在前列腺癌中不会看到它们，除非癌症已经非常晚期且有广泛转移。
You're welcome!
不客气！
The challenge for patients and physicians alike is to identify the causes of overlapping urinary symptoms, which are so common among men with either prostate cancer or BPH.
患者和医生面临的挑战是确定重叠泌尿系统症状的原因，这种症状在患有前列腺癌或前列腺增生症的男性中非常常见。
Hopefully this discussion was helpful.
希望这次讨论有帮助。
C.W.
C.W.
Schmidt , Editor, Harvard Medical School Annual Report on Prostate Diseases
施密特，哈佛医学院前列腺疾病年度报告编辑
Marc B.
马克·B.
Garnick, MD , Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing
Garnick，医学博士，哈佛医学院前列腺疾病年度报告主编；哈佛健康出版社编辑顾问委员会成员
As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
作为为读者提供的一项服务，哈佛健康出版社提供对我们存档内容库的访问。
Please note the date of last review or update on all articles.
请注意所有文章的最后审查或更新日期。
No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
本网站上的任何内容，无论日期如何，都不应替代您的医生或其他合格临床医生的直接医疗建议。
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