If you have difficulties with urination, see your doctor. This condition doesn't always relate to prostate cancer, but it can be a symptom of prostate-related problems.

If you're a man older than 50, you may want to see your doctor to discuss beginning prostate cancer screening.

Prostate cancer frequently doesn't produce symptoms. The first indication of a problem may come during a routine screening test. Screening tests include:

• Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.

• Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein and analyzed for PSA, a substance that's naturally produced by your prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if higher than normal levels are found, it may be an indication of prostate infection, inflammation, enlargement or cancer.

• Urine test. A sample of your urine is analyzed for abnormalities that may indicate a problem. This test doesn't detect prostate cancer, but it can help detect or rule out other conditions that may cause similar signs and symptoms.

• Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to get a picture of your prostate gland.

If initial test results suggest prostate cancer, your doctor may recommend a prostate biopsy. During a biopsy, small tissue samples are taken and analyzed to determine if cancer cells are present.

To do a biopsy, your doctor inserts an ultrasound probe into your rectum. Guided by images from the probe, your doctor identifies any suspicious areas. Then a fine, hollow needle is aimed at these areas of your prostate. A spring propels the needle into your prostate gland and retrieves a very thin section of tissue.

If an abnormal area is seen on the transrectal ultrasound, your doctor likely will biopsy that area. If no abnormality is seen, eight sections of tissue usually are taken from different areas of your prostate gland. Very large prostate glands may require more than eight biopsies to adequately assess the gland for cancer. A pathologist who specializes in diagnosing cancer and other tissue abnormalities evaluates the samples. From those, the pathologist can tell if it's cancer and estimate how aggressive your cancer is.

Once a cancer diagnosis has been made, you may need further tests to help determine if or how far the cancer has spread. Many men don't require additional studies and can directly proceed with treatment based on the characteristics of their tumors and the results of their pre-biopsy PSA tests.

• Bone scan. A bone scan takes a picture of your skeleton in order to determine whether cancer has spread to the bone. Prostate cancer can spread to any bones in your body, not just those closest to your prostate, such as your pelvis or lower spine.

• Ultrasound. Ultrasound not only can help indicate if cancer is present, but also may reveal whether the disease has spread to nearby tissues.

• Chest X-ray. X-ray films may show if the cancer has spread to your lungs, ribs or backbone.

• Computerized tomography (CT) scan. A CT scan produces cross-sectional images of your body. CT scans can identify enlarged lymph nodes or abnormalities in other organs, but can't determine whether these problems are due to cancer. Therefore, CT scans are most useful when combined with other tests.

• Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional images of your body using magnets and radio waves. An MRI can help detect evidence of the possible spread of cancer to lymph nodes and bones.

• Lymph node biopsy. A lymph node biopsy is the best way to determine whether cancer has spread to nearby lymph nodes. During the procedure, some of the nodes near your prostate are removed and examined under a microscope to determine if cancerous cells are present.

When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and cancer cells are compared with healthy prostate cells. The more different the cancer cells are from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly.

Cancer cells may vary in shape and size. Some cells may be aggressive, while others aren't. The pathologist identifies the two most aggressive types of cancer cells when assigning a grade.

The most common cancer grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer. Known as Gleason scores, named for the doctor who invented them, these numbers may be helpful in determining which treatment option is best for you. The Gleason score adds the grades of the two most aggressive types of cancer cells; therefore, scoring may range from 2 (non-aggressive cancer) to 10 (very aggressive cancer).

After the level of aggressiveness of your prostate cancer is known, the next step, called staging, determines if or how far the cancer has spread. Your cancer is assigned four stages based on how far it has spread:

• Stage I. Signifies very early cancer that's confined to a microscopic area and which your doctor can't feel.

• Stage II. Your cancer can be felt, but it remains confined to your prostate gland.

• Stage III. Your cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.

• Stage IV. Your cancer has spread to lymph nodes, bones, lungs or other organs.

Complications from prostate cancer are related to both the disease and its treatment. One of the biggest fears of many men who have prostate cancer is that treatment may leave them incontinent or impotent. Fortunately, therapies exist to help cope with or treat these conditions.

The typical complications of prostate cancer and its treatments include:

• Spread of cancer. Prostate cancer can spread to nearby organs and bones and can be life-threatening.

• Pain. Although early-stage prostate cancer typically isn't painful, once it has spread to bones, it may produce pain, which can be intense. Treatment can range from the use of over-the-counter pain relievers to prescription narcotics. Radiation also is commonly used to treat painful lesions. Often radiation and prescription pain relievers are combined.

• Not all people with cancer that has spread to bones have pain. Pain can be controlled, and there's no reason a person has to suffer with intense pain. If your doctor is unable to control your pain effectively, you may need to consult a pain specialist. While it's not always possible to make all of your pain go away, your doctor will work with you to try to control pain to a point where you're comfortable.

• Urinary incontinence. Both prostate cancer and its treatment can cause incontinence. Some men experience incontinence after surgery to remove the prostate. Treatment recommendations depend on the type of incontinence you have, how severe it is and the chance that it will improve given time. Treatments include behavior modifications (such as going to the bathroom at set times rather than according to urges), exercises to strengthen pelvic muscles (commonly called Kegel exercises), medications and catheters. If leakage problems have continued for a prolonged period without improvement, your doctor may suggest more progressive procedures. These procedures may include implanting an artificial urinary sphincter, placement of a sling of synthetic material to compress the urethra, or the injection of bulking agents into the lining of the urethra at the base of the bladder to reduce leakage.

• Erectile dysfunction (ED) or impotence. Like incontinence, ED can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications and vacuum devices that assist in achieving erection are available to treat ED. Medications include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). If other treatments fail, penile implants can be inserted surgically to help create an erection.

• Depression. Many men may develop feelings of depression after a diagnosis of prostate cancer or after trying to cope with the side effects of treatment. These feelings may last for only a short time, they may come and go, or they may linger for weeks or months. Depression that lingers and interferes with your ability to manage your life should be treated. Treatment may involve counseling or antidepressant medication. A combination of the two therapies often is successful.