AARP Hearing Center
Warning Signs of Prostate Cancer
What to look for to catch it early
Former U.S. President Joe Biden's family says that his prostate cancer has spread to other parts of his body.
Brandon Bell/Getty Images
Key takeaways
- Early prostate cancer often causes no symptoms. Symptoms usually signal advanced stages of the disease.
- Urinary issues don’t necessarily indicate cancer; they can result from an enlarged prostate.
- Ask your doctor if or when you should have a prostate cancer screening.
Former President Joe Biden’s prostate cancer has reportedly worsened and spread to his bones, putting the disease back into the media spotlight.
Biden’s son Hunter Biden told the BBC in a recent interview that the cancer has metastasized into his father’s bones and is “very debilitating.” In advanced stages, prostate cancer spreads to other parts of the body, which can include the liver, lungs, lymph nodes and bones.
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Although prostate cancer can be serious, as in Biden’s case, most men diagnosed with the disease don’t die from it. Caught early, this usually slow-growing cancer is often curable.
Early prostate cancer doesn’t usually cause symptoms, but more advanced cancer does. This is why it’s critical to understand prostate cancer symptoms and differentiate them from other prostate issues.
Understanding urinary symptoms
Your urine stream may not be what it used to be. It may be harder to start going, and when you finally do start, your flow may be more of a dribble. Because you can’t fully empty your bladder, you may find yourself running back and forth to the bathroom day and night. Although these symptoms can be troubling — and are worth a conversation with your doctor — they aren’t necessarily a sign of cancer.
Prostate Cancer Stats
Prostate cancer is the second most common cause of cancer death among American men. The American Cancer Society estimates that 333,830 men will be diagnosed this year and 36,320 will die from the disease. About 6 in 10 prostate cancers are discovered in men 65 or older; it’s rare in men under 40. About 1 in 8 men will be diagnosed with it during their lifetime.
“The vast majority of men with those symptoms don’t have prostate cancer,” says Dr. Todd M. Morgan, chief of urologic oncology at University of Michigan Health. They’re usually symptoms of benign prostatic hyperplasia, a noncancerous enlargement of the prostate.
As you age, your prostate grows and squeezes the urethra, the tube urine goes through to come out of your body. About half of men in their 50s and 60s and up to 90 percent of those in their 80s have an enlarged prostate — an annoying but treatable condition.
An enlarged prostate doesn’t raise your risk for prostate cancer, but the conditions can have similar symptoms.
Symptoms of enlarged prostate include:
- Trouble starting to urinate
- Slow stream during urination
- Leaking
- Sudden urgency to urinate
- Going more at night
- Inability to completely empty your bladder
- Pain after ejaculating or while urinating
- Changes in urine color or scent
Early prostate cancer symptoms also include:
- Blood in urine or semen
- More frequent urination
- Trouble urinating
- Waking up at night to urinate
Symptoms of advanced prostate cancer can include:
- Urine leakage
- Back pain
- Fatigue
- Pain in your bones
- Erectile dysfunction
- Weakness in your arms or legs
- Unintentional weight loss
What to do next
When you have urinary changes, a trip to your primary care provider or urologist is in order.
Your doctor will ask about urinary symptoms and consider your risks for prostate cancer. In addition to age, a family history — not only of prostate cancer but also of breast, ovarian, pancreatic or colon cancer — increases your chances for the disease.
Race matters too. “African American men have a higher risk of prostate cancer diagnosis and a more aggressive prostate cancer and higher risk of death compared to non-Hispanic white men,” explains Dr. Justin R. Gregg, an associate professor of urology and a health disparities researcher at the University of Texas MD Anderson Cancer Center.
Being overweight or obese, a smoker or exposed to certain toxins can also raise your risk, the Prostate Cancer Foundation reports.
Diagnosing prostate cancer
The evaluation for prostate cancer starts with a prostate-specific antigen (PSA) blood test, which measures a protein produced by prostate cancer cells. Normal prostate tissue also produces this protein, which can lead to false-positive results.
“It’s not a perfect test,” Morgan says, meaning you can have an elevated PSA but no cancer.
Ten to 15 years ago, when a PSA level was concerning, men most often underwent a biopsy, says Dr. James Eastham, a urologic surgeon at Memorial Sloan Kettering Cancer Center. “As a result, many were diagnosed with prostate cancer, but no one was discerning which cancers were less life-threatening and which needed immediate treatment.”
“PSA is prostate-specific, not cancer-specific,” Eastham says.
He also says, “PSA fluctuates.” When the test is repeated six weeks after the initial screening, many men show normal levels and can be monitored without needing a biopsy. If the level is still high, you can undergo a second-line screening test (also called a biomarker test, such as the PCA3 test or 4Kscore test) to determine whether your prostate cancer risk is low or high. Biomarker tests can be used in combination with the PSA test to get a better idea of your risk — something that’s key to guiding further treatment or monitoring, says Robert E. Reiter, a professor and director of the prostate cancer program at UCLA Health in Los Angeles.
“The whole realm of diagnosis has really changed over the last decade,” Reiter points out. “We’re reducing the overdiagnosis; we’re diagnosing more and more of those who really are at risk from their cancer.”
Still, a PSA test is the best general way to screen for prostate cancer, he notes.
When to Get Screened
The U.S. Preventive Services Task Force recommends against PSA tests for men age 70 and older. For men ages 55 to 69, the task force suggests discussing potential harms and benefits with a health care provider. The 2018 guidelines are being updated, the task force reports.
The American Cancer Society recommends discussing the test as early as age 40 in men with very high risk, at 45 in men with high risk, including African American men and those with a first-degree relative diagnosed with the disease before age 65, and at 50 in men with average risk who are expected to live for at least another decade. Generally, prostate cancer screening ends in your 70s, Reiter says.
Additionally, doctors can use a magnetic resonance imaging (MRI) scan to get a closer look at what’s happening before recommending an invasive biopsy. If the biopsy is needed, the MRI directs the doctor exactly where to check. If the MRI doesn’t show need for a biopsy, doctors will monitor things over time, Eastham explains.
Another diagnostic test is the often-dreaded digital rectal exam (DRE). But you shouldn’t fear it, says Eastham, who typically performs it when patients are already under sedation for a biopsy, if that’s needed. An MRI is usually better than a DRE for accuracy, he adds.
Prostate cancer treatment
If you are diagnosed with prostate cancer, you may think that means treating it right away, but this is where things can get tricky. Most men who have prostate cancer will die with it — not of it. That is, some prostate cancer tumors don’t grow and won’t be a threat during your life, so treatment may not be beneficial (and could cause side effects).
Whether to treat it depends on your Gleason score, which assigns your cancer to a grade on a scale of 6 to 10. “The Gleason 6 cancers, which are very common, are the lowest kind of prostate cancer,” Morgan says. “It’s basically impossible for them to leave the prostate.”
Research published this year in JAMA Oncology suggests that labeling Gleason 6 or Grade Group 1 (GG1) tumor as precancerous instead of cancerous may significantly reduce overtreatment. The researchers said that for tumors with that grade, which won’t cause symptoms or spread, it may not be beneficial to call them cancer or treat them — though up to 40 percent of men in the U.S. with these tumors do undergo treatment. The researchers say the move could encourage more men to get screened because it would lower concerns about overdiagnosis and overtreatment. As a result, fewer men would die from the disease, the report suggests.
Treating a low-grade cancer that’s unlikely to spread could unnecessarily expose you to surgery and radiation. Instead, your doctor may recommend active surveillance, which involves visiting the urologist every six months or so, for tests like a PSA or biopsy to monitor your condition, Gregg says.
Older men may get by with watchful waiting — a more laid-back strategy that includes a yearly PSA test but little else. “It’s a term that’s applied to patients who are older, where it’s really unlikely that surgery or radiation is ever going to be recommended,” Morgan says. “If somebody has a life expectancy of less than 10 years, even if the cancer changes, they’re likely not going to need treatment.”
There’s an increased use of focused treatments that can treat or remove part of the prostate that’s affected, and not all of it in the hopes of fewer side effects, Reiter says, adding that outcomes are improving because of advanced technology.
Don’t wait for warning signs
If you’re in your 50s or 60s, prostate cancer screening should be on your radar. “It allows us to pick up cancer many years earlier than we would otherwise,” Morgan says.
Screening can catch it early when those outcomes can be good, Reiter says.
Video: Signs of Prostate Cancer
Editor’s note: This story, first published Aug. 18, 2022, has been updated to include new information.
The key takeaways were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.
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