Prostate cancer symptoms

This page was reviewed under our medical and editorial policy by

Farshid Sadeghi, MD, Medical Director, Genitourinary Cancer Center, City of Hope Phoenix

This page was updated on December 19, 2022.

Prostate cancer is the most common cancer in men after skin cancer, so it’s important to understand the basics of the disease, as well as the prostate cancer risk factors.

The symptoms of prostate cancer may be different for each man, and any one of these symptoms may be caused by other conditions such as an enlarged prostate, prostatitis or benign prostatic hyperplasia (BPH). As a result, routine screening tests in the form of digital rectal exams (DRE) and prostate-specific antigen (PSA) tests are vital.

This article will cover:

Urinary symptoms with advanced-stage prostate cancer

In more advanced prostate cancers, because the cancer may extend from the periphery of the prostate toward its center, it may block the passage of urine through the prostate and lead to urinary symptoms, including:

  • Burning or pain during urination
  • Difficulty urinating, or trouble starting and stopping while urinating
  • More frequent urges to urinate at night
  • Loss of bladder control
  • Decreased flow or velocity of urine stream
  • Blood in urine (hematuria)
  • Blood in semen
  • Erectile dysfunction
  • Painful ejaculation

However, a large subset of patients with advanced-stage prostate cancer do not exhibit urinary symptoms. Diagnosing even more advanced stages of prostate cancer remains heavily dependent on PSA monitoring and the performance of a digital rectal exam.

Other advanced-stage prostate cancer symptoms

Men with advanced prostate cancer may experience additional symptoms. That’s because the cancer has spread from the prostate to other parts of the body, such as the bones or lymph nodes.

Signs of metastatic prostate cancer may include:

  • Swelling in legs or pelvic area
  • Numbness or pain in the hips, legs or feet
  • Bone pain that persists or leads to fractures

A wide range of treatment options are available for managing advanced cancer. These treatments kill cancer cells, but they may also help patients manage pain.

Recurrent prostate cancer symptoms

Prostate cancer that returns after treatment is considered recurrent. When it returns to the area around the prostate, the disease is classified as a local recurrence. If the cancer is found in another part of the body, the recurrent cancer is considered metastatic. If the cancer metastasizes (or spreads) outside the prostate, it most likely develops in the lymph nodes and bones first. Metastatic prostate cancer less commonly spreads to the liver or lungs.

After initial treatment for prostate cancer, PSA levels are expected to drop dramatically. The first sign of recurrent prostate cancer may be a rise in the PSA level as seen on a blood test. Other symptoms of recurrent cancer may depend on whether and where the cancer has spread. Symptoms include:

  • Blood in the urine
  • Difficulty urinating
  • Lower back pain
  • Fatigue
  • Difficulty breathing
  • Jaundice

Patients should discuss any symptoms with their doctor and ask about scheduling regular PSA tests after treatment.

Testing for prostate cancer

There is no one age for prostate cancer testing, but the American Cancer Society (ACS) makes recommendations about prostate cancer screenings based on age and family history. According to the ACS, patients in any of these groups should consider asking their doctor about testing:

  • Men age 50 or older who have an average risk of prostate cancer and a life expectancy of at least 10 more years
  • Men age 45 or older with a high risk, including African-American men and those with a first-degree relative (brother or father) who had prostate cancer before age 65
  • Men age 40 or older who have a higher risk, such as more than one first-degree relative diagnosed with prostate cancer at an early age

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Show references
  • American Society of Clinical Oncology (2022, February). Prostate Cancer: Statistics.
  • American Cancer Society (2020, June). Prostate Cancer Risk Factors.
  • National Cancer Institute (2017, July 11). Chemicals in Meat Cooked at High Temperatures and Cancer Risk.
  • American Cancer Society (2021, April 23). American Cancer Society Recommendations for Prostate Cancer Early Detection.  
  • American Cancer Society (2019, August). Signs and Symptoms of Prostate Cancer.
  • American Society of Clinical Oncology (2021, September). Prostate Cancer: Symptoms and Signs.  
  • Centers for Disease Control (2022, August 25). What Is Prostate Cancer?
  • American Society of Clinical Oncology (2021, January). Urinary Incontinence.
  • Kessler, A., Sollie, S., Challacombe, B., Briggs, K. and Van Hemelrijck, M. (2019), The global prevalence of erectile dysfunction: a review. BJU Int, 124: 587-599.
  • American Cancer Society (2019, August 1). Treatments for Prostate Cancer Spread to Bones.
  • American Cancer Society (2021, January 4). Screening Tests for Prostate Cancer.