Signs and Symptoms

Early-stage prostate cancer usually causes no symptoms at all. Many men with early prostate cancer feel completely well. However, in some cases early tumors might cause subtle signs, such as:

  • Urinary changes: including difficulty starting urination, a weak or slow urine stream, the need to urinate more frequently (especially at night), or trouble fully emptying the bladder. These symptoms are common and often due to benign prostate enlargement, not cancer, but should be checked by a doctor.

  • Blood in urine or semen: known as hematuria (blood in urine) or hematospermia (blood in semen), which can occasionally occur with early prostate cancer (though these symptoms are uncommon in early disease).

  • As prostate cancer grows or spreads beyond the prostate (advanced or metastatic prostate cancer), it can produce more noticeable symptoms. Signs of advanced disease can include:

  • Trouble getting an erection (erectile dysfunction) that is new or worsening, caused by cancer affecting nerves or blood flow that are important for erections.

  • Pain in the bones (if cancer has spread to bone) – often felt in the hips, spine, ribs, or pelvis. Persistent bone pain or aches in these areas can be a sign that prostate cancer has metastasized to the bones.

  • Numbness or weakness in the legs or feet, or even loss of bladder or bowel control. These symptoms can occur if prostate cancer spreads to the spine and presses on the spinal cord. Spinal cord compression is a medical emergency.

  • Unintended weight loss and fatigue (feeling very tired) are more general symptoms that can accompany advanced cancer.

  • It’s important to remember that many of these symptoms can be caused by conditions other than cancer, such as benign prostatic hyperplasia (BPH) or infections. For example, urinary difficulties are most often due to BPH, not cancer. If you experience any of these symptoms, see a healthcare provider for evaluation. They may recommend tests to determine if prostate cancer or another issue is the cause.

Screening

Screening tests aim to detect prostate cancer early (before symptoms develop). The two main screening methods are:

  • PSA Blood Test: This test measures the level of prostate-specific antigen (PSA) in the blood. PSA is a protein made by the prostate; elevated PSA levels can be a sign of prostate cancer. Typically, a PSA level under 4 ng/mL is considered normal for most men, while higher levels raise concern. However, there is no strict “safe” cutoff, as some men with low PSA can still have cancer and many with moderately elevated PSA do not have cancer. Generally:

    • A PSA persistently above 4 ng/mL often prompts further evaluation. About 1 in 4 men with a PSA in the 4–10 range will have prostate cancer on biopsy.

    • Higher PSA (e.g. >10) means a higher likelihood (>50%) of cancer.
      The PSA test is not perfect – levels can be raised by non-cancerous conditions like BPH or prostatitis (prostate inflammation) and even recent ejaculation or bike riding. Some prostate cancers also do not raise PSA much. Because of this, an abnormal PSA test usually warrants additional testing (repeat PSA, specialized PSA-related tests, or a biopsy) to confirm if cancer is present.

  • Digital Rectal Exam (DRE): In a DRE, a doctor inserts a gloved, lubricated finger into the rectum to feel the back surface of the prostate for any lumps, hardness, or irregular areas. The prostate lies just in front of the rectum, so this exam allows direct palpation. A DRE can be uncomfortable but is brief and usually not painful. Prostate cancers often begin in the peripheral zone (back part) of the gland, which is reachable by DRE. DRE is less effective than PSA blood testing at finding cancer, but it can detect some cancers PSA might miss. Doctors sometimes include a DRE as part of screening along with a PSA test.

Where can I get screened for prostate cancer?

The following organizations all have local doctors who can screen you for prostate cancer. Click on the links below to learn more about your options and to book an appointment.

References