Prostate cancer does not always cause noticeable symptoms in its early stages. In fact, many prostate cancers are found through screening or evaluation before a man develops any clear warning signs.
When symptoms do occur, they can overlap with those caused by benign prostatic hyperplasia (BPH), prostate infection and other urinary conditions. This means that having one of these symptoms does not automatically mean you have prostate cancer.
However, certain changes should not be ignored, particularly if they are new, persistent or getting worse. If you are also experiencing symptoms of an enlarged prostate, our guide to BPH and enlarged prostate explains how those symptoms are evaluated and treated.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
First, an Important Point About Prostate Cancer Symptoms
Early prostate cancer often causes no symptoms. This is one of the most important things to understand. The prostate is located below the bladder and surrounds part of the urethra.
A cancer that is still small and has not affected the urinary passage may not interfere with urination at all. As prostate cancer grows or spreads, however, it can cause urinary, sexual or systemic symptoms. With that in mind, here are five changes that should prompt medical evaluation.
1. New or Worsening Problems With Urination
Changes in the way you urinate can include:
- Difficulty starting the urine stream
- A weak or slow flow
- Stopping and starting while urinating
- Needing to urinate more frequently
- Feeling that the bladder has not completely emptied
- Needing to urinate repeatedly during the night
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
These symptoms can occur with prostate cancer, particularly when the prostate or a tumour affects the urinary passage. However, urinary symptoms are much more commonly associated with BPH or other non-cancerous conditions. Therefore, a weak urine stream or frequent urination should not be interpreted as proof of prostate cancer.
2. Blood in the Urine or Semen
Seeing blood in your urine or semen can be alarming, and it deserves medical attention. Blood in the urine may occur with several conditions, including urinary infections, kidney or bladder problems, prostate conditions and cancer.
Similarly, blood in the semen can have several possible causes and does not automatically indicate prostate cancer. Nevertheless, unexplained or persistent blood should be assessed rather than assumed to be harmless. A doctor may need to determine whether the source is the prostate, urinary tract or another part of the reproductive system.
3. Persistent Pain in the Back, Hips or Pelvis
Persistent pain in the lower back, hips or pelvis can have many causes, including muscle, joint and spinal conditions. In prostate cancer, ongoing pain in these areas can become more concerning when the cancer has spread to the bones.
This does not mean that ordinary back pain is a sign of prostate cancer. Most back pain has other causes. The concern is greater when the pain is persistent, unexplained or accompanied by other symptoms, particularly in a man who has known or suspected prostate cancer.
New bone pain should therefore be discussed with a healthcare professional rather than simply attributed to ageing or physical activity.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
4. Erectile Difficulties or Changes in Sexual Function
Difficulty getting or maintaining an erection can sometimes occur in men with prostate cancer. However, erectile dysfunction is not specific to prostate cancer. It can result from ageing, cardiovascular disease, diabetes, hormonal changes, medications, psychological factors and many other conditions.
In some men with prostate cancer, sexual difficulties may occur because of the disease itself or because of treatments such as surgery or radiation therapy.
Therefore, a new or persistent change in sexual function is worth discussing with a doctor, but it should not be interpreted as a cancer diagnosis on its own.
5. Unexplained Weight Loss, Fatigue or Weakness
Unintentional weight loss, persistent tiredness or weakness can occur with many medical conditions and are not specific to prostate cancer.
However, these symptoms may become more relevant when prostate cancer is advanced or has spread beyond the prostate. For example, advanced cancer can sometimes cause significant fatigue, weight loss or weakness.
If these changes occur together with persistent urinary symptoms, unexplained pain or other prostate-related concerns, they warrant medical evaluation. Unexplained weight loss or ongoing fatigue should never be dismissed simply because there is no obvious urinary symptom.
What About Urinary Retention?
Being unable to urinate at all is not one of the five classic warning signs of prostate cancer, but it is an important symptom that requires prompt medical attention.
Acute urinary retention is more commonly associated with conditions such as severe BPH, urinary blockage or other urinary problems. However, prostate cancer can also contribute to obstruction in some circumstances.
If you suddenly cannot pass urine despite having a strong urge to do so, this should be treated as a medical problem requiring urgent assessment.
Why These Warning Signs Do Not Automatically Mean Cancer
One of the most important messages when discussing prostate cancer symptoms is that most of these changes can have causes other than cancer. For example:
- A weak urine stream is common with BPH.
- Frequent night-time urination can occur with BPH, diabetes, sleep disorders and other conditions.
- Blood in the urine can result from urinary infections, stones or other urinary tract problems.
- Erectile dysfunction has many possible causes.
- Back pain is extremely common and is usually unrelated to cancer.
What If You Have No Symptoms?
Having no symptoms does not completely rule out prostate cancer. Early prostate cancer frequently causes no noticeable symptoms. This is one reason discussions about prostate cancer detection may involve risk assessment and screening rather than waiting for symptoms to appear.
Whether PSA testing or other screening is appropriate depends on factors such as age, family history, genetic risk and personal preferences. Screening decisions are best made after discussing the potential benefits and limitations with a healthcare professional.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
How Is Prostate Cancer Checked?
If symptoms or other findings raise concern, a doctor may begin with a medical history and physical examination. Depending on the situation, this can include a digital rectal examination (DRE) and a PSA blood test.
PSA can provide useful information about prostate health, but it cannot by itself confirm prostate cancer. PSA can also be elevated because of BPH, prostatitis and other non-cancerous conditions.
If the overall assessment suggests that cancer may be present, further testing may include prostate MRI and, when appropriate, a prostate biopsy.
A biopsy is important because it allows prostate tissue to be examined under a microscope. This is what establishes a tissue diagnosis of prostate cancer.
The Bottom Line
The five warning signs to be aware of are new or worsening urinary problems, blood in the urine or semen, persistent pain in the back, hips or pelvis, changes in erectile function, and unexplained weight loss or persistent fatigue.
However, these signs should not be treated as a checklist for diagnosing prostate cancer. Many of them are caused more often by benign conditions such as BPH or by other health problems. At the same time, early prostate cancer may produce no symptoms at all.
The most useful approach is to pay attention to persistent or unusual changes and have them evaluated rather than trying to determine the cause yourself. A doctor can combine symptoms, examination findings, PSA testing and, when appropriate, imaging or biopsy to establish whether further investigation is needed.
Recognising concerning changes is important, but so is understanding that having a warning sign does not mean you have cancer. The purpose of evaluation is to find the actual cause and, when cancer is present, identify it as early and accurately as possible.
