Symptoms and diagnosis of metastatic prostate cancer

Symptoms of metastatic prostate cancer

Symptoms depend on which part of you body is affected by the cancer. Urinary problems or bone pain are the most common symptoms when advanced prostate cancer is diagnosed, but starting treatment often improves these symptoms.

If your prostate gland is enlarged, you may:

Have difficulty passing urine
Pass urine more often day and night
Feel your bladder isn’t empty after going to the toilet

If the cancer is affecting your bones, you may have:

A nagging ache in a particular bone
More severe bone pain
Weakened bones that break easily
Too much calcium in your blood, which can cause tiredness, constipation, nausea, thirst and confusion

Some symptoms may be vague, such as weight loss, erection problems and feeling unwell, unusually tired or weak.

All these symptoms can be caused by conditions other than cancer, but it’s important to go to the GP and get any unusual changes checked. If you have been diagnosed with prostate cancer, tell your doctor if you have any new symptoms.

Spinal cord compression

Spinal cord compression happens if the cancer presses on your nerves. Although this is a less common symptom, it’s very important to treat spinal cord compression urgently. Go to your doctor immediately if you have symptoms such as pain, weakness or tingling in your leg, reduced mobility, or loss of bladder and bowel control. If you can’t see a doctor, go to a hospital emergency department and explain that you have metastatic prostate cancer. Read more about spinal cord compression.

We have more information on managing side-effects and symptoms of metastatic prostate cancer.

What tests will I have?

You may have tests to find out how far the cancer has spread. If you are generally not very well it may not be necessary to do extra tests. Your doctor will still be able to recommend treatment. Some of these tests can also be used to check how you are responding to treatment.

You may have some or all of the following tests:

PSA blood test

Prostate specific antigen (PSA) is a protein that can rise due to disease in your prostate gland. A sample is taken from your blood and measured. A PSA test can also show how well your cancer is responding to treatment.

Biopsy

A biopsy is where a sample of your prostate tissue is taken and examined under a microscope. It isn’t common to have a biopsy with metastatic prostate cancer, but if this is your first prostate cancer diagnosis it may be necessary. Treatment can still start without a biopsy.

Bone scan

Metastatic prostate cancer often spreads to the bones. Bone scans can find cancer spots before they show up on an ordinary X-ray. For this test, a tiny amount of radioactive liquid is put into a vein, usually in your arm. After the injection you will have to wait up to 3 hours. A scan is then taken of all the bones in your body. Abnormal bone takes up more radioactive liquid than normal bone. These areas will show up on the scan and are known as 'hot spots'. The scan can also show bone changes like arthritis.

It's nice to have someone with you to keep you company if you're having this test, as it takes a while and involves a bit of waiting around.

X-ray tests
You may have bone X-rays if the bone scan shows up ‘hot spots’. These X-rays will help to confirm if the cancer has spread or not. A chest X-ray may be done to check your general health.

MRI scan
A scan that uses magnetic energy to build up a picture of the tissues in your chest, abdomen and pelvis. During the scan you will lie inside a tunnel-like machine.

CT scan
This is a special type of X-ray that builds up a detailed picture of the tissues around your chest, abdomen and pelvis. The scan is painless
and takes 10-30 minutes.

PET scan
This scan uses a low dose of radioactive sugar to measure the activity of your cells. This sugar is first injected into your arm and
travels to all the cells in your body.

PSMA-PET scan
This scan uses a special antibody molecule and radioactivity to look for areas of the body where the PSMA protein is found, showing the presence of prostate cancer cells. It is often used when there is biochemical recurrence.