Man discussing prostate cancer signs with his doctor
Prostate cancer is one of the most common types of cancer in men, ranking only behind lung cancer in deaths. About 1 in 8 men will be diagnosed with prostate cancer during their lives, according to the American Cancer Society (ACS). Those numbers are grim, but here’s some brighter news.
“It is a completely curable disease if detected early, such as while the cancer is still localized to the prostate and has not spread,” says Dr. Ramkishen Narayanan, MD, a board-certified urologist and urologic oncologist and Director of the Center for Urologic Health at The Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center.
In fact, the ACS puts the five-year survival rate for local and regionalized prostate cancer at about 99%. Understanding your risk and signs and symptoms of prostate cancer can be life-saving. Yet, the cancer still has a stigma.
“Because the prostate is in a sensitive area involving urination and sexual function, men tend to avoid talking about their diagnosis,” Dr. Narayanan says. “Fortunately, we are gradually seeing a shift in men more openly communicating with their friends and the public about prostate cancer.”
Doctors also want to continue to communicate and spread awareness about the signs of prostate cancer. One symptom involves pain in an unexpected place.
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The #1 Unexpected Prostate Cancer Sign, According to Urologists
Believe it or not, bone pain is a potential prostate cancer symptom. Unfortunately, people with prostate cancer who are experiencing this pain likely have the metastatic kind, meaning it has spread. “The bones of the pelvis and the spine are common first areas of metastasis for prostate cancer,” says Dr. Daniel Phillips, MD, a urologist with Memorial Hermann. “Pain in these regions may be evidence of a possible prostate cancer in these locations.”
Dr. Narayanan says that bone pain can also be a sign of prostate cancer recurrence in patients who have already had the disease. The link between prostate cancer and bone pain may be a surprising one. However, urologists have explanations.
“When prostate cancer cells try to metastasize, [which means cancer] spread outside of the organ, they first try to get to the lymph nodes near the prostate, called the pelvic lymph nodes, and second most commonly, the bone,” Dr. Narayanan says.
Dr. Narayanan explains the cells may also try to get to the bone, specifically the bony pelvis and spine/vertebrae. He urges people to seek medical care ASAP if they experience new bone pain, especially if they have risk factors for prostate cancer, like elevated prostate-specific antigen (PSA) and a family history of prostate cancer.
What if you’ve already had prostate cancer? “New bone pain can be a sign of disease recurrence,” Dr. Narayanan says.
Notably, Dr. Vishnukamal Golla, MD, the medical director for value transformation at Evolent, says some patients with prostate cancer will never experience this symptom. Other times, the bone pain is a sign of something else.
What Else To Know About Bone Pain and Prostate Cancer
1. It’s new or worsening
Dr. Phillips explains that the pain is generally new and worsening and often appears in the back, ribs or joints. Dr. Narayanan says people who have lived with low back pain for years may brush off this prostate cancer sign.
“It is important to remember that in older men with chronic low back pain, [doctors] should ask if there has been a noticeable change in their pain,” Dr. Narayanan says.
Patients can and should also flag worsening pain.
2. It can feel dull or stabbing
The way someone feels pain varies. However, one urologist can offer some common words patients with prostate cancer use to describe the bone pain that brought them to the doctor’s office.
“Bone pain is typically described as a dull ache or stabbing sensation that is generally constant,” Dr. Golla says. “Sometimes, the pain can be intense enough to wake someone up from sleep.”
3. It may be worse at certain times
“Patients can feel bone pain from prostate cancer throughout the day, but it commonly is worse for patients at night,” says Dr. Jennifer Anger, MD, a urologist and co-author of A Woman’s Guide to Her Pelvic Floor: What the F*@# is Going On Down There.
Dr. Phillips says other patients may notice the pain is more pronounced when they are active.
4. It can have a ripple effect
Unfortunately, the bone pain linked to prostate cancer poses other risks.
“Metastatic prostate cancer in the bones can weaken the bone structure, resulting in fractures that are not associated with trauma such as a fracture from getting out of bed or walking normally,” Dr. Golla says.
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Other Signs of Prostate Cancer
Bone pain isn’t the only potential red flag of prostate cancer. Dr. Anger says someone might have blood in the urine if the cancer spreads outside of the prostate and into the urinary tract.
“They can also have weakness and weight loss from metastatic disease,” Dr. Anger continues.
Dr. Golla adds that blood in semen and erectile dysfunction can indicate prostate cancer. However, Dr. Phillips stresses you may not experience prostate cancer symptoms, especially early in the disease.
“The most important point I emphasize with my patients is that most prostate cancers are asymptomatic,” Dr. Phillips says.
How Doctors Screen for Prostate Cancer
Since prostate cancer is often asymptomatic, early screening is critical. “PSA screening is the most important,” Dr. Narayanan says. “Early access or referral to your urologist also helps gauge your urinary health. In coordination with your primary care doctor, we as urologists can quarterback your urologic care and ensure you have access to tests such as the prostate MRI, which has been a game-changer in early prostate cancer detection.”
Understanding family history can also help you advocate for early testing.
The good news? “Prostate cancer is completely curable when detected early, while the cancer is still localized to the prostate and has not spread to the lymph nodes or the bone,” Dr. Narayanan says.
Treatment for Metastatic Prostate Cancer
If you have bone pain and prostate cancer, it’s likely to have spread. “Bone pain from cancer and the diagnosis of a metastatic prostate cancer can be scary for patients,” Dr. Phillips says. “However, with current advances in the management of prostate cancer, patients will, in most cases, have long and fulfilling lives after their diagnosis. Even in advanced disease, the time scale is most often in years rather than months.”
But how? “When prostate cancer has spread, the mainstay of treatment is medications that block the influence of testosterone,” Dr. Phillips says. “Prostate cancer is highly dependent on testosterone and the blockade of this hormone can be an effective treatment. Many other treatments also exist, including more advanced hormonal treatments, targeted agents, as well as more traditional chemotherapy.”
Lowering Prostate Cancer Risk
You can’t completely eliminate your chances of developing prostate cancer. However, you can control some risk factors. “While there are no miracle vitamins in terms of supplements, there are certain dietary changes that generally show positive benefits for patients living with cancer, including prostate cancer,” Dr. Golla says.
For instance, diets linked with better heart health can also reduce prostate cancer odds or slow its progression if you already have it—a win-win.
“Heart-healthy diet recommendations include having more of a plant-based diet rich in fruits, vegetables, whole grains and healthy fats,” Dr. Golla says. “This also includes eating less meat and refined carbohydrates and opting for healthier vegetable fats.”
Research published in Cancer 2024 also indicated that plant-based diets can lower the likelihood of erectile dysfunction and urinary incontinence in prostate cancer patients.
Dr. Narayanan said regular exercise and not smoking (or quitting if you do) can also slash your risk.
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