Prostate Cancer: Signs and Symptoms

Most early prostate cancer causes no symptoms at all. The prostate sits deep in the pelvis, wrapped around part of the urethra, the tube that carries urine out of the body. A small tumor inside it usually does not press on anything or cause pain. This is a big reason prostate cancer is often found through a PSA blood test or a routine exam, not because a man noticed something wrong.

When prostate cancer does cause symptoms, they are often urinary. These include:

• A weak or interrupted urine stream
• Needing to urinate often, especially at night
• Trouble starting urination
• A feeling that the bladder has not fully emptied

Here is the catch: these same symptoms are far more often caused by a non-cancer condition called benign prostatic hyperplasia, or BPH. That is a normal, common enlargement of the prostate with age. Most men with these symptoms do not have cancer. But because the two overlap, new or worsening urinary symptoms are worth mentioning to a doctor, so the cause can be sorted out.

Blood in the urine or semen is a less common but more specific symptom. It happens with prostate cancer, but also with infections, an enlarged prostate, or other non-cancer causes. Either way, blood where it should not be needs a medical evaluation. Do not assume it will resolve on its own.

Prostate cancer that has spread beyond the gland can cause a different set of symptoms. Erectile dysfunction can occur. Unintended weight loss and severe fatigue can occur too. Bone pain is common, especially in the hips, lower back, or ribs, because prostate cancer often spreads to bone.

One symptom deserves special attention: new weakness or numbness in the legs or feet, or a sudden loss of bladder or bowel control. This can mean cancer in the spine is pressing on the spinal cord. This is a medical emergency, measured in hours.

Call 911 or go to an emergency department the moment these symptoms appear. Do not wait for a scheduled appointment, and do not settle for leaving a message on the clinic line. Treatment started quickly gives the best chance of protecting movement and bladder control; nerve damage left too long may not come back.

It is worth repeating: most of the symptoms above are far more often caused by something other than prostate cancer. Urinary symptoms are usually BPH. Bone pain has many other causes, especially in older men. The point of knowing these symptoms is not to assume the worst. It is to know what is worth mentioning to your doctor, and to recognize the one pattern — leg weakness, numbness, or loss of bladder or bowel control — that needs emergency care rather than a wait for your next visit.

Because early prostate cancer is usually silent, waiting for symptoms means waiting past the point when treatment tends to work best. A PSA blood test measures a protein made by the prostate. It cannot diagnose cancer by itself, and a high PSA can come from BPH, infection, or recent activity rather than cancer. For men age 55 to 69, the U.S. Preventive Services Task Force recommends an individual decision, made with a doctor, weighing the chance of catching a serious cancer early against the risk of unnecessary biopsies and treatment for a slow-growing cancer that may never have caused harm. This is a conversation worth having before symptoms appear, not after.

• Are my urinary symptoms more likely BPH or something that needs further testing?
• Should I have a PSA test, and what would the result mean?
• What symptoms should prompt me to call you right away, versus wait for my next visit?
• If I ever develop leg weakness or lose bladder control, what should I do immediately?

• American Cancer Society — Signs and Symptoms of Prostate Cancer
• American Cancer Society — Prostate Cancer Risk Factors
• U.S. Preventive Services Task Force — Prostate Cancer: Screening