What are the Most Common Signs of Prostate Cancer?

Prostate cancer is one of the most common types of cancers. Most of the time, prostate cancer doesn’t cause any symptoms. So screening tests, like the prostate-specific antigen (PSA) blood test, more commonly find it.

But sometimes people experience changes in their bodies and urinary habits that may be signs of prostate cancer. Symptoms of prostate cancer can come from the tumor itself as it grows inside the prostate or because the cancer spreads to other parts of the body (metastasis). 

Let’s review the five symptoms prostate cancer is most likely to cause. 

1. Trouble urinating

A tumor in the prostate can press on the urethra, which is the tube that carries urine from the bladder to the penis. This pressure partially blocks off the urethra, and this can cause symptoms like:

• A need to strain to start to urinate

• A weak urine flow 

• A urine stream that starts and stops

A compressed urethra makes it harder to fully empty the bladder. So you may also feel like you have to pee more frequently, especially at night. You may also feel a sudden need to pee (urgency) or like you still have urine in your bladder even after you urinate.

2. Blood in urine or semen

Visible blood in the urine can be a sign of several medical conditions, including prostate cancer. Although blood is red, it may look different when it mixes with urine. When there’s blood in it, urine can look pink, red, or brown. The change to these shades of color can be subtle or obvious. 

Some people may also notice that their semen is a different color, too. This can also be from small amounts of blood. 

As the tumor grows inside the prostate, it can press on nearby structures like the bladder and parts of the body that make semen. This pressure leads to irritation and bleeding. The blood gets mixed into urine and semen as these fluids travel through these structures and out of the body.

3. Erectile dysfunction

Erectile dysfunction isn’t a common sign of prostate cancer. But sometimes, the tumor can grow large enough that it also starts to press down on smaller, nearby structures like blood vessels and nerves that control the penis. 

These smaller structures are more flexible than larger organs like the bladder. So they aren’t bothered by tumors until those tumors become very large. Compressed blood vessels and nerves don’t work properly. Nerves can’t properly send signals to the penis, and blood vessels can’t deliver enough blood to the penis. Without these two things, people have trouble achieving and maintaining an erection. 

4. Bone and joint pain

Bone and joint pain can be signs of advanced prostate cancer. If prostate cancer spreads (metastasizes), it often travels to the bone. This can lead to constant, nagging pain in bones and joints. 

Most of the time, prostate cancer grows very slowly. So it’s not common for people to experience bone and joint pain as a first sign of prostate cancer. In fact, only about 5% of people have widespread prostate cancer when they’re first diagnosed. 

5. Weakness and fatigue

Cancer cells can grow quickly. To fuel their growth, they use a lot of the body’s energy and nutrients. People may feel tired and overly fatigued when they have prostate cancer. This usually happens if the cancer has spread.

What can cause prostate cancer?

Experts aren’t sure exactly what causes prostate cancer, but it’s likely the result of a combination of things. A person’s genes likely play a role in whether they develop prostate cancer. Studies show that prostate cancer can run in families. 

People are also more likely to develop prostate cancer as they get older. So how a person’s genes respond to the aging process likely plays a role, too.

Being exposed to certain things throughout your lifetime can also raise your risk of developing prostate cancer. There’s data showing that people who smoke are more likely to develop prostate cancer. Eating a high-fat and meat-based diet can also raise the chances of developing prostate cancer. 

What to do if you’re experiencing symptoms of prostate cancer

If you’re having symptoms that could be a sign of prostate cancer, your healthcare provider can help. They can check for some of the more common causes of these symptoms. And they can help you figure out if you may need more testing.

Many of the symptoms of prostate cancer are subtle and overlap with other conditions. In fact, a symptom like frequent urination is more likely to be caused by conditions that aren’t as serious as prostate cancer. Benign prostate hyperplasia (BPH), for example, can cause a slow urine stream as the prostate grows bigger with age. Similarly, infections of the urinary tract or prostate can cause difficulty urinating, frequent urination, and bloody urine.

Diagnosis and testing

If you’re worried about prostate cancer, your healthcare provider may recommend the following tests:

• PSA testing: This is a screening blood test for prostate cancer.

• Rectal exam: This is the best way to feel the prostate gland. A healthcare provider briefly inserts a finger into the rectum to check the size and shape of the prostate. This isn’t everyone's favorite part of a visit to their provider, but it’s an important part of a routine physical exam.

Depending on the results of these tests, your healthcare provider may recommend more tests to look for prostate cancer, like:

• Prostate biopsy: This is a small procedure that collects cells from the prostate for testing. The cells are then analyzed with a microscope to see if they look cancerous.

• Imaging studies: An ultrasound or MRI can look for areas of the prostate that might be suspicious for cancer.

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Written by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Brandon R. Mancini, MD, MBA, FACRO

Brandon R. Mancini, MD, MBA, FACRO, serves as medical director at BAMF Health in Grand Rapids, Michigan in the emerging field of theranostics. His primary clinical focus is on the treatment of people with metastatic prostate and neuroendocrine cancers.

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