Prostate cancer symptoms

Prostate cancer may not cause symptoms at first.^1,2

It may not be until the cancer grows and makes the prostate bigger or that it spreads that people start to notice that something may be wrong.^1,2

Even then, the symptoms experienced may be shared with other common conditions that can affect the prostate gland of men over 50. ^1,2

One of these is benign prostatic hyperplasia or BPH.³ This is a condition where the prostate becomes larger than normal and can squeeze the tube (urethra) through which urine is passed.³ This can make it difficult or painful to pee,³ which are also symptoms of prostate cancer.²

Signs and symptoms of localised and locally advanced prostate cancer^1,2

Signs and symptoms of metastatic prostate cancer^1,2

Getting a prostate cancer diagnosis

There is no single test for prostate cancer.⁴ A doctor may make the diagnosis based on a combination of factors:⁴

• the doctor’s clinical suspicion based on symptoms and signs
• the person’s risk factors, such as their age, ethnicity and family history
• the results of a physical or clinical examination
• the results of blood and urine tests

Digital rectal examination

One of the simplest tests that a doctor or specialist nurse may do is a digital rectal examination or DRE.^5,6

This is a physical examination that involves the insertion of a single gloved finger into the back passage (rectum).^5,6

By doing this, the healthcare professional can gently feel the prostate and decide if there is anything unusual that might need further investigation.^5,6

PSA test

A blood sample may be taken to measure the levels of prostate-specific antigen (PSA).^6,7

This is a protein that can be produced by both normal prostate cells and prostate cancer cells. If prostate cancer is present, PSA levels may be consistently higher than normal,¹ although this is not always the case.^1,7

Indeed, PSA can be high when there is:⁸

• urine infection
• prostate infection (prostatitis)
• enlargement of the prostate (BPH)

PSA levels can also be higher after physical activities, such as cycling or after having sex.

Abnormal PSA results do not mean that a person has prostate cancer or, if they do, that they need to be treated.⁶ This is one of the reasons why PSA testing is not routinely used to screen the general population for prostate cancer in the same way as mammograms are used to screen for breast cancer.

DRE and PSA tests are usually combined. The results of multiple PSA and DRE tests can be used to check how well treatment for prostate cancer is working.

Urine test

A urine sample may be taken to rule out an infection as the cause of any urinary symptoms that may be present.⁴

Imaging

If a diagnosis of prostate cancer is suspected then you may be referred for an imaging scan to confirm this.^1,4

Imaging methods can help to determine if you have localised, locally advanced or metastatic prostate cancer. This in turn can help determine which prostate cancer treatment might be the most suitable.^1,4

Imaging methods used include:^1,4

• MRI (magnetic resonance imaging) scan
• CT (computed tomography) scan
• PET (positron emission tomography) scan

Another imaging method that might be used, although not for diagnosis, is a bone scan.^1,4 A bone scan may be done if it is suspected that you have developed metastatic prostate cancer and the cancer has spread into the bone.^1,4

Prostate biopsy

Depending on the results of the physical (DRE) examination or PSA test, your doctor may refer you to hospital to have a biopsy taken.^1,4

A biopsy is when samples of tissue from the prostate gland are taken for further analysis.¹ The results should confirm whether prostate cancer is present or not.

Transrectal ultrasound scan guided (TRUS) biopsy

A slim ultrasound probe is inserted into the back passage (rectum). This creates images that enable the operator to see where to place a needle and take 10-12 samples of prostate tissue.^1,4 Since this can be uncomfortable or painful, a local anaesthetic may be given.³ Antibiotics may also be needed to reduce the risk of infection.^1,4

Transperineal biopsy

A transperineal biopsy is usually performed under general anaesthesia.⁴ This involves a needle going into the skin behind the scrotum.⁴ Again, a few tissue samples will be obtained that can then be examined under the microscope to look for cancer cells.⁴

What happens to the biopsy tissue?

The tissue obtained from the prostate biopsy will be looked at under the microscope. Cells within the tissue will be graded according to how similar they look when compared with healthy prostate cells.¹

The grading system for prostate cancer is called the Gleason grading system.¹ Under this system cells are given a Gleason grade between 1 and 5, where 1 indicates the cells look normal and 5 indicates that they are abnormal.

An overall Gleason score is calculated based on all the tissue samples obtained during the biopsy. The higher the Gleason score, the more likely the prostate cancer will grow and spread.¹

References

1. Esmo Prostate cancer guide for patients. Available at: https://www.esmo.org/for-patients/patient-guides/prostate-cancer (Accessed: September 2025).
2. Prostate cancer – Prostate cancer symptoms. Available at: https://www.nhs.uk/conditions/prostate-cancer/symptoms/ (Accessed: September 2025).
3. Prostate Cancer UK. England prostate. https://prostatecanceruk.org/prostate-information/further-help/enlarged-prostate (Accessed: September 2025).
4. Irish Cancer Society. Symptoms and diagnosis of prostate cancer. https://www.cancer.ie/cancer-information-and-support/cancer-types/prostate-cancer/symptoms-and-diagnosis-of-prostate-cancer (Accessed: September 2025).
5. Prostate Cancer UK. Digital rectal examination (DRE). https://prostatecanceruk.org/prostate-information/prostate-tests/digital-rectal-examination-dre (Accessed: September 2025).
6. Prostate Cancer UK. Getting checked for prostate cancer. Available at: https://www.prostate-cancer-research.org.uk/getting-checked-for-prostate-cancer/ Accessed September 2025.
7. NHS. Prostate cancer – PSA test. Available at https://www.nhs.uk/conditions/prostate-cancer/psa-testing/. (Accessed: September 2025).
8. The PSA blood test: https://prostatecanceruk.org/prostate-information-and-support/prostate-tests/psa-blood-test (Accessed: September 2025).