Symptoms of Prostate Cancer

The signs and symptoms of prostate cancer may include frequent urination, urgency, or a need to urinate during the night. Men may also notice that they have difficulty starting to urinate as well as a decreased force of urination. Less common symptoms can include finding blood in the urine or semen, or the sudden onset of erectile dysfunction. Symptoms may also occur due to complications of prostate cancer, such as back and hip pain if cancer spreads to bones.

While today, most men are diagnosed with prostate cancer before they begin to have symptoms (via PSA screening and digital rectal exams), it's important to be familiar with the possible signs of the disease. This is especially important for men who have not undergone screening or are young and have not yet been screened.

prostate cancer symptoms
Illustration by Verywell

Frequent Symptoms

Symptoms of prostate cancer are largely related to the anatomy of the prostate. The prostate gland is located just below the bladder in the lower pelvis. As urine exits the bladder, it travels through a thin tube called the urethra, which passes directly through the prostate. 

When a cancer is present, the resulting enlargement and inflammation of the gland can cause the urethra to be pinched, impeding the flow of urine. Frequent symptoms related to this narrowing of the urethra include:

Frequency of Urination

Urinary frequency is one of the most common symptoms of prostate cancer. Most people don't document how often they urinate each day, but men might notice that they make sure to go to the bathroom before leaving home. They may find that they need to stop more frequently when traveling by car, or that they make sure to note the sites of onboard bathrooms when traveling by plane.

Urgency of Urination

Not only can prostate cancer lead to frequent urination, but it can cause a sense of urgency—the sensation of having to urinate right away. Men might notice that they need to walk rapidly to the bathroom or wonder if they will make it in time.

Having to Urinate at Night (Nocturia)

Having to urinate at night (nocturia) is very common in older men, and hearing that this can be a symptom of prostate cancer can be frightening. There are many causes of nocturia, only one of which is prostate cancer.

With prostate cancer, a change in urinary habits is usually more significant than the habits themselves. If you did not ordinarily get up to urinate and do now, you should talk to your doctor. If you did ordinarily get up once at night to urinate and now need to do so two or three times, it's likewise important to seek medical attention. 

Difficulty Starting to Urinate (Hesitancy)

Having difficulty starting the stream of urine (hesitancy) is also common as men age, but can be a sign of prostate cancer or other conditions as well. Most people have experienced hesitancy at some time, such as when feeling rushed in the bathroom. Hesitancy that occurs or is increasing, even when a man is unhurried and comfortable at home, should be addressed.

Decreased Force of Urination

Men may also notice a decreased force or difficulty maintaining a steady stream when they urinate, and because of this, that it takes longer to empty their bladder. In addition, dribbling may occur, and there may be a sensation that the bladder is not completely empty. Again, this can be a relatively normal finding as men age, but if the change is abrupt or changing rapidly, it should be evaluated.

Less Common Symptoms

Though not common, other symptoms of prostate cancer may also occur. While these are less specific to the prostate gland and can be caused by a wide range of conditions, they should be evaluated.

Blood in the Urine (Hematuria)

Blood in the urine (hematuria) is more likely to be due to another condition but can occur with prostate cancer.

Blood in Semen (Hematospermia)

Passing blood in semen (hematospermia) can be an alarming symptom and should be evaluated. As with hematuria, blood in the semen has a number of possible causes. Blood in the semen may be bright red or just have a faint pink color. 

Sudden Onset of Erectile Dysfunction

Erectile dysfunction is a common symptom as men age, but is usually gradual in onset. If erectile dysfunction develops rapidly, it may be a cause for concern.

Pain in the Back, Hips, or Ribs 

When prostate cancer spreads, the bones are the most common site of metastases. Metastases to bones in the back, hips, or ribs can cause pain that may be severe.

Loss of Bladder Control

Loss of bladder control is not a common symptom of prostate cancer but may occur for more than one reason. In addition to direct causes related to a tumor, prostate cancer may spread to the bones in the lower back resulting in spinal cord compression and loss of bladder control.

Unintentional Weight Loss

Unintentional weight loss, often accompanied by a decreased appetite and fatigue, may occur when prostate cancer is advanced. Other symptoms that suggest a prostate cancer has spread beyond the prostate may include a change in bowel habits or swelling in the legs and feet.

Complications

Prostate cancer may cause complications when it spreads locally, or when it spreads to other parts of the body by way of the bloodstream or lymphatic system. Potential complications include:

Pelvic Pain

Prostate cancer can lead to chronic pelvic pain due to the invasion of soft tissue in the pelvis.

Urinary Retention

Prostate cancer may cause urinary retention via obstruction of the urethra or, when more advanced, due to obstruction of the ureters (the tubes that travel from the kidneys to the bladder). When the urethra is completely blocked by an enlarged prostate, it is referred to as "acute urinary retention." With a partial blockage, a man may instead experience chronic urinary retention.

Acute urinary retention is usually accompanied by extreme pain as pressure builds up in the bladder as it fills and becomes distended with urine. If not relieved, urine can back up to the kidneys leading to infection and kidney damage. In other words, a complete inability to urinate is a medical emergency.

Fortunately, placing a catheter can often quickly relieve the obstruction. That said, a medication to reduce the size of the prostate or surgery to remove the obstruction may be needed to prevent recurrent obstruction in the future.

Incontinence

Incontinence can be a side effect of surgery for prostate cancer but can have other causes as well, such as spinal cord compression due to bone metastases.

Bone Metastases

As noted earlier, the bones are the most common site of prostate cancer metastases. Sometimes, in people who have not had screening, it may be the first symptom of the disease. Bone metastases can lead to:

  • Pain: The pain associated with bone metastases is sometimes severe, but there are a number of treatments available. Pain is most often felt in the lower back, hips, or ribs.
  • Fractures: When prostate cancer spreads to bones it can weaken the structure of the bone. Fractures that occur through these areas of weakened bone are referred to as pathologic fractures and may sometimes occur with only minimal trauma—or even with something as simple as rolling over in bed.
  • Spinal cord compression: Metastases to the spine can cause a collapse of the vertebrae that protect the spine. The resulting nerve compression can lead to lower back pain that radiates down the legs, weakness, burning or tingling in the arms or legs, and loss of bowel and bladder control. This is a medical emergency; immediate treatment is needed to prevent permanent damage. Treatment may include steroids, radiation, or surgery. 
  • Hypercalcemia: Prostate cancer may result in hypercalcemia (an elevated level of calcium in the blood) due to the breakdown of bone from metastases and other mechanisms. Symptoms may include nausea and vomiting, confusion, and when severe, coma, if not treated.

    When to See a Doctor

    If you experience any of the symptoms above, it's important to see your doctor. There are many possible causes of many of these signs, and they, too, are important to diagnose.

    That said, when it comes to diagnosing prostate cancer, it's best not to wait until symptoms appear. Talk to your doctor about the screening tests available. If you have a family history or other risk factors for prostate cancer, especially if a relative was diagnosed with the disease at a young age, it is even more important to be screened. For some men, testing may be recommended starting at an earlier age than for men who don't have risk factors.

    If you are under 50 or haven't undergone prostate cancer screening, it is important to see a doctor if any of the above-listed symptoms develop. None should be considered "normal." Even erectile dysfunction should be discussed with your doctor. As with many cancers, early treatment is associated with not only better outcomes but a reduction in treatment-related side effects.

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