Prostate cancer is the most common cancer in men — roughly one in eight will develop it at some point. Awareness campaigns remind us of this constantly, yet most men still don’t know how to actually recognize the signs themselves, or that the most common “sign” might be no sign at all. Here’s a rundown of what actually shows up, and why the absence of symptoms doesn’t mean the absence of disease. (Based on the insights of Associate Professor Charles Chabert, a urologist.)
Key Takeaways
- The most common presentation of prostate cancer is no symptoms at all — cancer growing in a quiet part of the gland doesn’t press on anything nearby.
- Bone pain is a rare but serious sign, usually indicating the cancer has already spread — worth checking if persistent and unexplained, especially in older men.
- Urinary symptoms and erectile dysfunction are more commonly caused by benign, age-related changes than by cancer, but shouldn’t be ignored.
- Screening focuses on higher-risk groups — Black men, men over 55, and those with a strong family history — using the imperfect PSA blood test.
- Autopsy studies show many older men have undiagnosed, harmless prostate cancer — it’s often “the cancer you die with, not the cancer you die from.”
Bone Pain (Uncommon, but Serious)
This is relatively uncommon as a first sign, but it’s the most concerning when it does happen. Prostate cancer that has already spread often moves to bone, and in rare cases, persistent bone pain — like an unrelenting backache — can be the only symptom present. This is genuinely rare as an initial presentation, but older men with ongoing, unexplained bony pain that won’t resolve should get it checked with a doctor, since occasionally that’s the only clue available.
Blood in Urine or Semen
This symptom tends to get attention because it’s alarming, which is arguably a good thing — it drives people to seek care quickly. The reassuring part: blood in urine or semen is far more likely to be caused by something other than prostate cancer. Still, it shouldn’t be ignored, since it can be one of the ways prostate cancer presents.
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