Prostate cancer red flags including sensation in legs according to doctor

A doctor has spoken about the ‘red flags’ for prostate cancer, and added that anyone who has them should see their GP as soon as possible - including a little known sensation in the legs. Dr Mark Porter spoke out in his Times column as the Medicines and Healthcare Regulatory Agency has sent an alert to doctors reminding them to warn men taking finasteride, a widely used drug for bladder and prostate problems, that it may have worrying psychiatric and sexual side-effects.

Dr Porter highlighted the key signs of problems with the potentially lethal disease and said: ”Some red flags to be aware of: blood in your urine, which is never normal and should always be reported, a burning sensation (suggestive of infection) and any change in bladder function accompanied by back pain, or weakness and/or altered sensation in the legs or pelvic area (suggestive of nerve compression).

Dr Porter said tha non-cancerous enlargement of the prostate was very common - and explained in benign prostatic hyperplasia (BPH) the gland increases in size from about the age of 40, and by 60 at least half of men will have BPH, increasing to 90 per cent or more by 85. And in many, but not all, it will have a noticeable impact on bladder function.

He added: “Not every man with BPH will have symptoms, and not everyone with symptoms will have BPH, but telltale signs include needing to get up in the night for a pee (once is normal), a weakened stream, peeing more often during the day, and having trouble getting started when you do, or stopping when you have finished.

“And men often unwittingly make their symptoms worse by going to the loo just in case before trips out of the house — as do many women with continence issues — accelerating any reduction in bladder capacity. And so starts a downward spiral.”

He said caffeine can make symptoms worse, as well as oral decongestants such as pseudoephedrine, antihistamines used in cold and flu remedies, as well as some types of OTC sleeping pills. Testing can include urine testing, a PSA blood test - levels can be raised in both BPH and cancer - and sometimes kidney function too.

Dr Porter said measuring urine output and taking the results to the GP was a good idea. He said an adult bladder will normally send the first gentle signals that it needs emptying at 150-250ml,with more insistent signals above 400ml. “Even those with good capacities are normally getting desperate by 600ml. However, if your chart shows that you are bursting to go but only passing 100-200ml at a time, then you have a problem. Not all such cases will be due to BPH, but if examination reveals your gland feels significantly enlarged then it’s likely to be a factor.”

Treatment can include medication to relax the outlet of the bladder (eg tamsulosin) or hormone blockers to shrink the gland (eg finasteride”. Bladder training to try to stretch the bladder capacity by hanging on longer and stopping “just in case” trips to the loo can help some, as can bladder pills to relax the muscular wall. Surgery can be used to open up the narrowed urethra, but is generally reserved for more extreme cases.