Sadly, many men don't find out they have prostate cancer until the cancer has spread, making it more difficult to treat. This is because in the early stages, prostate cancer often doesn't have many symptoms. That's a problem because prostate cancer is the second most common kind of cancer in American men, after skin cancer.
The good news is that there are signs to be alert for. If you or a man in your life notices any of these changes, it's important to head to the doctor for a checkup sooner rather than later.
Keep in mind: Each of these signs has other possible causes, and one sign alone isn't something to panic about. But by paying close attention to what your body is doing, and by talking candidly with your doctor about what you're feeling, you may be able to get relief -- and possibly even spot prostate cancer early, if it arises.
1. Difficulty urinating. This may take the form of feeling like you have to go and then nothing comes out, stopping midstream, or having to go more often. Another sign is difficulty stopping, which often takes the form of extended dribbling, or the feeling that you still have to go even when you're done. Because the prostate gland surrounds the urethra -- the tube that carries both urine and semen -- even a very small tumor in this location can interfere with urination or ejaculation. Bear in mind, however, that the prostate gland becomes enlarged in many men as they age, and this enlargement, known as benign prostatic hyperplasia (BPH), is the more likely cause of urinary problems.
2. Pain while urinating. Again, the problem may be a prostate tumor pressing on the urethra. However, pain while urinating is a classic symptom of infection in the urinary tract. It can also signal an infection of the prostate, known as prostatitis.
3. Blood in the urine. This sign is less common, and it's a reason to go straight to the doctor. It doesn't have to be very much blood; all you might notice is a pinkish tint or smear. Blood in the urine is often caused by infections in the bladder or prostate, by kidney stones, and by BPH. However, in some cases it's due to a tumor in the prostate, bladder, or kidney.
More Signs of Prostate Cancer That Often Go Unnoticed
4. Difficulty getting or keeping an erection. Yes, this one's really hard to talk about. But if it's not happening when you want it to, or things get stuck "half-mast," it's time for a checkup. (Female partners need to tread delicately around this one, but if it's happening often enough to interfere with your sex life on a regular basis, find a moment to introduce the subject in a kind and nonthreatening way.) Erectile problems are often caused by atherosclerosis (fatty buildup along the arteries), which can reduce blood flow to the penis, but they can also be due to a prostate tumor that interferes with erections or ejaculation.
5. Blood in the semen. This sign, like blood in the urine (#3), is often not described very clearly. It's not a large amount of blood, more like just enough to make semen pinkish or streaked, according to men with prostate cancer. Gals, you can help with this one too; if you notice an odd color to semen after sex, speak up.
6. Chronic constipation and other intestinal issues. The prostate gland is located below the bladder and in front of the rectum, so a tumor in this location can interfere with digestive functions. However, it's sort of a chicken-and-egg situation; chronic constipation can contribute to an enlarged prostate by putting pressure on the gland, and vice versa. Chronic constipation and intestinal problems can also be early indicators of colon cancer. A good general rule is this: If you're suffering from constipation, gas, or other intestinal symptoms that don't go away when you modify your diet, talk to the doctor.
7. Frequent pain in the lower back, hips, or upper thighs. The most common sites for prostate cancer to spread are the lower back, pelvis, and hips. Unexplained pain and tenderness in these areas are signs of trouble. One way to distinguish this type of pain from run-of-the-mill sciatica and lower back pain is that it may feel deeper and more like a dull ache. However, experts say any lower back or hip pain that doesn't go away is a reason to see the doctor.
Possible Early Signs of Prostate Cancer
8. Having to pee in the middle of the night. This is one of the sly symptoms that men diagnosed with prostate cancer say they remember, now that they look back. If you find yourself waking more than once a night urgently needing to go, a trip to the doctor is in order. Bear in mind, though, that this symptom is far more likely to be caused by BPH or an overactive bladder than by prostate cancer.
9. Leaking or dribbling urine. Here's one almost no one talks about, but we need to. It's basically the male version of urinary incontinence, which typically occurs on a small but still noticeable scale. Longer bathroom trips while you wait for the dribbling to stop or leakage on the way to the bathroom are the telltale signs. Women, if while doing the laundry you notice that his pants or jeans smell like pee, delicately suggest a visit to the doctor. As the doctor will explain, this symptom is most likely due to BPH or overactive bladder, but, combined with other symptoms, it may indicate that more testing is in order.
10. You're over 50 and have risk factors. Since early prostate cancer most often has no symptoms at all, men who are at risk need to talk to their doctors and consider having regular PSA tests and rectal exams (sorry!), whether they notice anything odd happening or not. Family history -- especially a father who had prostate cancer -- being overweight, eating a high-fat diet, being of African-American descent, and smoking all increase your risk of prostate cancer. Another one many men don't know: If the women in your family have a history of breast cancer, you may carry faulty genes that increase your prostate cancer risk.
If you're wondering just how high your risk for prostate cancer is, consider trying one of the available online prostate cancer risk calculators:
What You Should Know About Being Evaluated for Possible Prostate Cancer
Once you bring your symptoms to your doctor's attention, you'll want to discuss possible next steps. Unfortunately, there's currently no good, simple way to determine whether a man's symptoms are due to prostate cancer or not. Doctors often use the prostate-specific antigen (PSA) test, both to screen men without symptoms and to evaluate men with symptoms. However, multiple studies have shown that the PSA test is often high in men without cancer, and it can be low in men with cancer. In 2012, the U.S. Preventive Services Task Force recommended against routine PSA-based screening for prostate cancer. This means that to really evaluate for cancer, a biopsy of the prostate is usually necessary.
Despite the controversies surrounding PSA testing of men without symptoms, PSA testing does remain an important step in evaluating a man who does have symptoms of possible prostate cancer. Still, it's good to discuss the implications of testing with your doctor before having this test.
If you're concerned about prostate cancer or need more information about screening, check out the Center for Disease Control's handy Prostate Screening Decision guide.