Prostate cancer is the second most common cancer among men worldwide, affecting about one in seven men during their lifetime1 . Most men with early-stage prostate cancer do not experience symptoms, making screening crucial for early detection and treatment2 . When symptoms do appear, they often indicate a more advanced stage of the disease and can include urinary problems, blood in urine or semen, and pain in bones or other areas3 .
Key Prostate Cancer Symptoms
Prostate cancer primarily affects the prostate gland, a small organ located below the bladder that surrounds the urethra, the tube that carries urine out of the body4 . As the cancer grows, it can obstruct the urethra or irritate the urinary tract, leading to various urinary symptoms.
Frequent Urination and Nocturia
Frequent urination means needing to urinate more often than usual, and it is a common symptom in men with prostate cancer5 . Nocturia refers to waking up at night to urinate. Normally, the body reduces urine production at night, allowing most people to sleep six to eight hours without needing to urinate6 . However, prostate cancer can disrupt this process.
Nocturia is often associated with prostate cancer but is also common in benign prostatic hyperplasia (BPH) and aging4 . Both conditions can cause obstruction or irritation of the urinary tract, leading to increased nighttime urination.
Urinary Urgency
Urinary urgency is the sudden, strong need to urinate, which may be uncomfortable or painful5 . This symptom occurs because prostate cancer can irritate the urinary tract or obstruct urine flow through the urethra5 . Urinary urgency often accompanies other lower urinary tract symptoms (LUTS), such as frequency and nocturia.
Difficulty Urinating
Difficulty urinating includes symptoms like urinary hesitancy (trouble starting urination), weak urine stream, and incomplete bladder emptying5 . These symptoms result from the tumor pressing on or blocking the urethra5 . While these symptoms are common in prostate cancer, they are also frequently caused by benign conditions like BPH, making clinical differentiation challenging4 .
- Lower urinary tract symptoms (LUTS) such as nocturia, urgency, frequency, and incomplete voiding are common but not highly predictive of prostate cancer on their own5 .
- Obstructive symptoms are reported in about 56% of prostate cancer cases, and irritation symptoms in about 53% 4.
“For prostate cancer to cause symptoms, it may be at an advanced stage when it becomes harder to cure.”
— Lisly Chéry, M.D., MD Anderson Cancer Center2
Additional Warning Signs
Beyond urinary symptoms, prostate cancer can cause other less common but important signs that may indicate disease progression.
Painful Ejaculation
Painful ejaculation is a symptom that can occur in prostate cancer, though it is less common5 . The severity and duration of pain can vary among individuals. This symptom may result from tumor involvement near the reproductive structures.
Blood in the Urine or Semen
Hematuria (blood in the urine) occurs in about 26% of prostate cancer cases4 . Hematospermia (blood in the semen) is less common but can also be a sign of prostate cancer5 . These symptoms arise when the tumor irritates or blocks blood vessels or the urethra, causing bleeding5 .
Sudden Onset Erectile Dysfunction
Erectile dysfunction (ED) is the inability to achieve or maintain an erection5 . While ED is often related to aging or benign prostatic hyperplasia, sudden onset of ED can be a symptom of prostate cancer5 . The cancer can damage nerves involved in erectile function, leading to this problem5 .
- Hematuria and hematospermia may result from tumor pressure on the urethra or blood vessels5 .
- Erectile dysfunction often develops gradually with age but can present suddenly in prostate cancer5 .
Symptoms of Advanced Prostate Cancer
When prostate cancer progresses beyond the prostate gland, it can spread (metastasize) to other parts of the body, causing more serious symptoms.
Pain in the Back, Hips, or Chest
Bone metastases are the most common site of spread in prostate cancer5 . The cancer frequently spreads to the spine, pelvis, ribs, and sometimes the skull7 . This can cause persistent bone pain, often in the back, hips, or chest, which may worsen at night or with activity7 . Bone metastases can weaken bones and increase the risk of fractures7 .
Swelling in the Legs or Feet
Swelling in the legs and feet can occur due to lymph node involvement by cancer cells5 . The lymph nodes are part of the lymphatic system, which collects and filters excess fluid from body tissues4 . When cancer blocks lymphatic drainage, it causes fluid buildup and swelling, known as lymphedema5 .
Unintentional Weight Loss
Cancer cells consume a large amount of the body’s energy, leading to increased calorie burning and unintentional weight loss4 . Weight loss is a common symptom in advanced prostate cancer and often accompanies fatigue5 .
💡 Did You Know?
Prostate cancer affects one in seven men, making it the second most common cancer among men worldwide. It can be curable, especially when identified and treated early1 .
Spinal cord compression can occur if cancer spreads to the spine, causing numbness, weakness, or other neurological symptoms in the legs or feet5 . This is a medical emergency requiring prompt treatment to prevent permanent damage5 .
- Bone metastases cause pain and increase fracture risk7 .
- Lymphatic obstruction leads to swelling and discomfort in lower extremities5 .
- Fatigue and weight loss are frequent in advanced disease5 .
- Spinal cord compression symptoms include numbness and weakness5 .
Metastatic prostate cancer means cancer that began in the prostate has spread to another part of the body. Symptoms include bone pain, fatigue, feeling generally unwell, and unexplained weight loss7 .
When to Seek Medical Care
It is important to see a healthcare provider if you experience symptoms suggestive of prostate cancer, especially if they are persistent or worsening5 . Early evaluation helps distinguish prostate cancer from other conditions like benign prostatic hyperplasia or prostatitis, which can cause similar symptoms5 .
Seek medical care promptly if you notice:
- Difficulty starting urination or weak/interrupted urine flow8 .
- Blood in urine or semen5 .
- Sudden erectile dysfunction5 .
- Persistent bone pain, especially in the back, hips, or ribs7 .
- Swelling in the legs or feet5 .
- Unexplained weight loss or fatigue4 .
- Numbness, weakness, or loss of bladder/bowel control5 .
Early diagnosis and treatment improve outcomes and may prevent complications2 .
“If you have any of the following symptoms, be sure to see your doctor right away: Difficulty starting urination, Weak or interrupted flow of urine.”8
Summary of Prostate Cancer Signs
Prostate cancer often begins without symptoms, making screening essential for early detection9 . When symptoms occur, they typically involve the urinary tract due to tumor growth obstructing or irritating the urethra. Common signs include frequent urination, nocturia, urinary urgency, and difficulty urinating4 5.
Less common symptoms include painful ejaculation, blood in urine or semen, and sudden erectile dysfunction5 . Advanced prostate cancer may cause bone pain, swelling in the legs, unintentional weight loss, and neurological symptoms from spinal cord compression4 57.
Because many symptoms overlap with benign conditions like BPH, any persistent urinary or related symptoms should prompt medical evaluation5 . Early diagnosis allows for more effective treatment and better prognosis.
- Prostate cancer is often symptom-free in early stages but can cause urinary symptoms as it progresses2 9.
- Frequent urination, nocturia, urgency, and difficulty urinating are common but not specific to prostate cancer4 5.
- Blood in urine or semen and painful ejaculation are less common warning signs5 .
- Advanced disease may cause bone pain, swelling, weight loss, and neurological symptoms4 57.
- Prompt medical evaluation is crucial for diagnosis and treatment8 .
