Prostate Cancer Screening Can Detect Cancer Early Before Symptoms Show

By Andrew Wilson

When you search the internet for symptoms of prostate cancer, you will find pretty much the same thing on every site:

  • difficulty urinating,

  • decreased force in the urine stream,

  • blood in the urine or semen, and

  • erectile dysfunction.

Dr. Arthur Thomas

But there’s two problems with that list. Each sign is usually caused by something else besides prostate cancer, and, if they are caused by prostate cancer, it could mean your prostate cancer is very advanced.

“What I tell my patients is that prostate cancer usually has no symptoms until it is advanced,” said Arthur Thomas, M.D., a board-certified urologist with St. Clair Medical Group. “It’s a disease that should be screened for. Like most cancers, the chances of a cure are very good when caught in an early stage, but the chances go way down if it advances to later stages.”

The same websites will say that prostate cancer is usually a very slow-moving form of cancer, which may cause some men to feel that “slow-moving” equates to “not serious.” That could be a fatal mistake. The American Cancer Society lists prostate cancer as the second leading cause of death for men in the United States, behind lung cancer and just ahead of colorectal cancer.

“That statement (slow-moving) might be true for the vast majority, but it may not be true for you,” cautioned Dr. Thomas. “For that reason, we do try to encourage every guy to get screened. If you are diagnosed with prostate cancer, it doesn’t always mean that you need treatment. In my opinion, some of the greatest advancements in prostate cancer have been in the encouragement of active surveillance for low-risk disease.”

“Most cancers we will find with a PSA blood test,” said Dr. Thomas. PSA stands for Prostate-Specific Antigen and measures the presence of a certain protein in the blood which, at elevated levels, can mean cancer. “There are other diagnostic tools that we may use before doing a biopsy, such as an MRI of the pelvis, and some other urine and blood tests, but they usually only provide additional information and may or may not change management beyond what the PSA already showed.”

All cancers are categorized by different stages. For prostate cancer, Stages I and II mean the cancer is localized to the prostate. Stage III means the cancer has started growing out of the prostate. Stage IV is when the cancer has spread to lymph nodes, other organs, or directly invaded a nearby organ.

In classifying prostate cancer, the American Urological Association breaks it down into risk stratification which helps to direct therapy. Low risk means the cancer is usually recommended to not proceed directly to treatment and instead to do active surveillance. The next stratus, intermediate risk, is broken down into two categories: favorable and unfavorable. Favorable behaves less aggressively than unfavorable, but both are usually recommended to have treatment such as surgery or radiation, unless the patient’s age or health dictates otherwise. High risk almost always requires treatment unless a patient has otherwise very advanced poor health or age.

Obviously, for Stage IV or high risk, the cancer is more difficult to treat successfully, but Dr. Thomas offers some hope. “There have been advances in treatment and medical oncology that are able to hold even metastatic cancer at bay for many years.”

Dr. Thomas says if a man is healthy and under age 65, surgery may be the best course of treatment. Over age 65, the treatment may be surgery or radiation, possibly with a combination of hormonal therapy. There are also other treatment methods using ultrasound and freezing treatments that some physicians have used, but they are not usually the standard of care.

“The survival rates for prostate cancer are pretty good,” said Dr. Thomas. “The five-year survival rate for someone with low-risk cancer is 99 percent. If the cancer has metastasized, the five-year survival rate drops to 32 percent.”

That underscores the need for screening before any symptoms present. Still there is a psychological aspect to prostate cancer that must be overcome. Many men delay getting screened because they fear they will not be able to urinate as usual and/or they will not be able to be intimate with their partner any longer. Dr. Thomas has good news on both of these counts, too.

“After treatment, most guys are quickly able to regain urinary function,” he said. “Most are able to maintain intimacy, too, but they just have to work at it a little more.”


Dr. Thomas practices with St. Clair Medical Group Urology, one of St. Clair Health's premier community-based specialty practices. The team of five highly-skilled physicians with multiple subspecialties are united in their mission to deliver unprecedented urologic care to the South Hills. To make an appointment with Dr. Thomas or learn more about the practice, please call (412) 942-4100 or visit stclair.org/scmg-urology.