Let's Talk About the Signs and Symptoms of Prostate Cancer
This common cancer in older men is highly treatable when caught early. Learn how you can spots the signs of prostate cancer.
Do you get up often in the middle of the night to pee? Do you have difficulty getting a stream to start? Or maybe it burns when you go? While other common conditions may explain these symptoms, they can also signal prostate cancer—so never ignore them. Just as important? Discussing prostate cancer with your doctor BEFORE any obvious symptoms appear, because treating the disease in its early stages significantly ups your odds of surviving it. Here, we’ll walk you through the tell-tale signs of prostate cancer so you can pursue a full, cancer-free life.
Our Pro Panel
We went to some of the nation's top experts in prostate cancer to bring you the most up-to-date information possible.
Edmund Folefac, M.D.
Ohio State University Comprehensive Cancer Center
Isla P. Garraway, M.D.
Associate Professor and Director of Research
Department of Urology, David Geffen School of Medicine at UCLA
Daniel Ari Landau, M.D.
Medical Oncology and Hematology Specialty Section, Orlando Health UF Health Cancer Center
Much more needs to be learned about the causes of this disease before experts will be able to offer a prostate cancer prevention plan. Unfortunately, you can’t avoid aging, which is the number-one risk factor for prostate cancer.
Nine out of 10 men who are diagnosed with prostate cancer learn the news before they have any signs or symptoms of this disease through screening. More advanced disease can brings on symptoms like blood in your urine or semen, erectile dysfunction, and problems with urination.
Lots of treatment options exist, such as surgery, radiation, hormone treatments, and more. What’s best for you will be determined by your particular cancer and how fast it’s growing. For most men, treatment is very successful.
That’s not an easy question. Experts don’t know what causes prostate cancer, but they do know that your risk goes up as you get older, if you are African American, or if prostate cancer runs in your family. If other cancers, like breast and ovarian cancer, occur in your family, you may have a gene, called BRCA, that raises your risk of prostate cancer.
What, Exactly, Is the Prostate and Prostate Cancer?
Your prostate plays an important part in your ability to father children. Located in front of your rectum and below your bladder, this one ounce, walnut-shaped gland helps produce semen, that milky fluid that carries sperm through and then out of your penis when you ejaculate. Its partners in this job are glands called seminal vesicles, which are attached to your prostate. Nearby nerves, blood vessels, and muscles help get your penis erect in the first place.
Things can go wrong with your prostate, though. Cells can start to grow and multiply in ways that they shouldn’t. Eventually, this growth forms a tumor. What triggers this process remains unclear, but there’s good news: While prostate cancer is the most common cancer in men, it tends to grow very slowly—so slowly, in fact, it may never require treatment.
According to the American Cancer Society (ACS), 98% of men diagnosed with prostate cancer will live at least five more years. In fact, when prostate cancer is diagnosed early, before it has spread to other parts of the body, the survival rate is close to 100%.
And because prostate cancer most frequently occurs in older men—the average age of diagnosis is 66—those who have it are more likely to die of other causes. As many doctors who treat prostate cancer like to point out, most men die with prostate cancer rather than from it.
Even so, prostate cancer can sometimes be aggressive. When this happens, it can grow quickly into a life-threatening disease. Why this occurs in some men remains a mystery. Approximately one man out of every 41 with prostate cancer will die from the disease. In 2020, it is expected to take the lives of more than 33,000. This makes it critical for you to not only know the warning signs and symptoms of prostate cancer but also to understand the complexities regarding whether you should be screened for the disease and what the diagnosis process involves.
Is There a Difference Between a Sign and a Symptom?
While both signs and symptoms of prostate cancer provide your doctor with clues that can help reveal your health status, they are not quite the same.
Signs are things that can be measured or otherwise witnessed by your doctor. A good example is a blood test (such as the PSA test), which we’ll discuss below.
Symptoms are a bit more personal. They’re what you experience but they can’t be objectively measured. You may feel fatigue, for example, but that won’t show up in an exam. You have to tell your doctor about it.
What Are Some Common Signs and Symptoms of Prostate Cancer?
When it comes to the signs and symptoms of prostate cancer, there’s both good news and bad news. Let’s get the bad out of the way first: Prostate cancer does not make its presence known in an obvious manner until it has progressed significantly.
That means you may be quite ill by the time you notice that there’s something wrong. In such situations, the prognosis—or, how successful treatment is likely to be—is often not as hopeful as you’d want it to be. That said, here’s the good news to keep in mind: Many of the clues below can be traced to other, less serious health conditions. You should never ignore them, but you should also know they don’t automatically mean you have cancer.
This can take on a number of forms. You may have to go more often than usual, especially at night. You also may have trouble starting a stream, or you may have a weak stream while you pee. Finally, you may have to strain to empty your bladder.
Rest assured that these kinds of symptoms often don’t indicate prostate cancer. It’s much more likely that they’re caused by an enlarged prostate, something that happens to many men as they get older. Called benign prostatic hyperplasia, or BPH, this condition is not an early sign of cancer, nor does having it make you more likely to develop cancer. However, do talk to your doctor about it. You’ll want to have cancer ruled out.
Blood in Your Urine
Called hematuria, the presence of blood in your urine has numerous possible explanations, including BPH. It can also indicate a urinary tract infection or kidney infection. Or, you may learn that you have a kidney or bladder stone.
These possibilities do require medical care, but they are not a cancer diagnosis. Prostate cancer must also be ruled out, because the disease can cause blood in the urine if a tumor grows to the point that it squeezes your urethra.
Blood in Your Semen (Hematospermia)
No doubt this will set off alarm bells, but it often does not indicate anything dire. You may have an infection of your seminal tract, the path that sperm follow on their journey from your testicles to the outside world.
Less frequently, bloody semen may result from a sexually transmitted infection, like chlamydia or gonorrhea. If you’ve had a vasectomy recently, that may be to blame. Only rarely does it indicate prostate cancer. Talk to your doctor if you notice blood in your semen. You want to be certain it does not indicate cancer.
Erectile Dysfunction (ED)
There are MANY reasons men may have problems getting and maintaining an erection. It’s rare that prostate cancer is the cause, though ED may indicate prostate cancer if it occurs suddenly rather than develops gradually. If cancer is the reason, it likely means the disease is quite advanced. Keep in mind that medications for BPH may make erections more difficult for a small number of men because they affect the male sex hormone testosterone. Surgery for BPH also could result in ED, but this is quite rare.
Other signs and symptoms that may indicate more advanced prostate cancer:
Bone pain. This occurs if your prostate cancer affects your bones, which is often the first place prostate cancer travels once it has metastasized, or spread beyond your prostate.
Loss of bowel control. If your tumor presses against nerves in your spine, it can cause you to lose control of your bowels. Though uncommon, prostate cancer can spread to the rectum and cause symptoms such as constipation and bleeding.
Swelling in your feet and legs. This can occur if the cancer spreads to your lymph nodes and causes a condition called lymphedema, in which your lymphatic system becomes blocked and fluid from your lymph nodes gets backed up.
Unexplained weight loss. If you’re suddenly shedding pounds without trying to, it may indicate advanced prostate cancer that has spread. About 60% of people with advanced prostate cancer will develop cachexia, a condition that causes a significant loss of weight and muscle that can’t be restored even if you get plenty to eat.
Who Should Be Screened for Prostate Cancer?
The vast majority of men who get diagnosed with prostate cancer—we’re talking about nine out of 10 guys—learn they have the disease before any symptoms begin. That’s thanks to advancements in modern screening, which checks for the presence of prostate cancer before symptoms make themselves obvious.
So, should you get screened? Seems like a no-brainer, right? That every man would automatically say yes, right? But it’s not always as straightforward as that.
Before we go further, let’s first detail who should definitely get screened for prostate cancer:
Beginning at age 50, the ACS recommends that all men discuss the pros and cons of screening with your doctor.
If you’re at higher risk of prostate cancer, this discussion should take place:
At age 45 for African American men, and for men who have a first-degree relative—meaning, a father or brother—who has or had prostate cancer.
At age 40 for men who have more than one first-degree relative diagnosed with prostate cancer, and for men with a family history of either breast or ovarian cancers linked to the BRCA gene mutations.
Men over 70, and those who are not expected to live more than 10 more years due their current health or age, should not be screened. Even if they have prostate cancer, the disease likely won’t cause symptoms during the remainder of their lives.
So, Why Is Screening for Prostate Cancer Not Always Done?
Now come the nuances—the “cons” we just mentioned about prostate cancer screening. Sometimes screening tests can leave you with more questions than answers, or lead you down a medical rabbit hole when you might not have cancer at all.
Testing doesn’t always give simple “yes” or “no” answers, and can trigger more invasive procedures when your cancer status remains unclear. That’s why screening, important as it is, can be a bit tricky. Let’s address some of these uncertainties now.
Tests May Be Inaccurate or Unclear
Typically, doctors will do a blood test called a PSA (prostate-specific antigen) and/or a digital rectal exam (DRE), in which the doctor feels your prostate for any abnormal growths or hard spots. A normal prostate is smooth and soft. The problem: Both tests can be wrong on occasion.
Though uncommon, a test can sometimes indicate no cancer when cancer actually exists. Called a false negative, such a result may cause you to miss out on treatment when it may have been most helpful, in cancer’s early stages. (Still, fewer than 1% of men with a cancer that may require treatment receive a false negative, according to a study published in 2018.)
Or, your test could tell your doctor that you likely have cancer when you really don’t. This is known as a false positive. Such a result can lead to, say, an unnecessary biopsy that may be painful, cause bleeding. and potentially cause an infection.
Screening May Not Help You Live Longer
Quite often, prostate cancer moves so slowly it will never cause symptoms or threaten your life. Finding and treating such cancers may do more harm than good. The flipside, of course, is that screening can catch a less-common but aggressive, potentially deadly cancer—and a missed opportunity to diagnose it could have grim consequences.
Here’s what your PSA results tells your doctor:
Under 4 nanograms per milliliter (ng/mL) usually means there’s no cancer; however, about one in six men with a PSA at this level will be diagnosed with prostate cancer once they undergo further testing.
Between 4 and 10 ng/mL indicates a 25% risk of prostate cancer.
Above 10 ng/mL boosts the risk to above 50%.
What Can I Expect If Screening Tests Indicate Prostate Cancer?
If you do undergo prostate cancer screening and the results suggest you may have cancer, your next steps will be a biopsy, aided with imaging tests (including CT scans and an ultrasound), and possibly bone scans. Together, they will confirm whether or not you do have prostate cancer, how aggressive (or fast-growing) your cancer is, whether or not prostate cancer treatment is required at this time, and if your prostate cancer has spread.
So, deep breath. Remember, while you should never ignore the signs and symptoms of prostate cancer, from trouble peeing, to erectile dysfunction, to blood in your semen or urine, these important clues may indicate a whole host of other health conditions, all of which require medical attention.
Even if screening and subsequent testing reveal you do have prostate cancer, there are many effective treatment options available at this time, and the vast majority of men with this condition go on to live and thrive, eventually becoming cancer-free.
- Prostate Cancer (1): American Cancer Society. (2019). “What Is Prostate Cancer?” cancer.org/cancer/prostate-cancer/about/what-is-prostate-cancer.html
- Prostate Cancer (2): American Urological Association. (2018). “What Is Prostate Cancer?” urologyhealth.org/urologic-conditions/prostate-cancer
- Prostate Cancer Statistics: American Cancer Society. (2020). “Key Statistics for Prostate Cancer.” cancer.org/cancer/prostate-cancer/about/key-statistics.html
- Prostate Cancer Causes: American Cancer Society. (2019). “What Causes Prostate Cancer cancer.org/cancer/prostate-cancer/causes-risks-prevention/what-causes.html
- Prostate Cancer Genetic Risk Factors: European Urology. (2019). “Prostate Cancer Risks for Male BRCA1 and BRCA2 Mutation Carriers: A Prospective Cohort Study.” europeanurology.com/article/S0302-2838(19)30675-X/abstract
- Prostate Cancer Diagnosis: American Cancer Society. (2020). “Tests to Diagnose and Stage Prostate Cancer.” cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html