Symptoms of metastatic prostate cancer

Metastatic prostate cancer means that a cancer that began in the prostate gland has spread to another part of the body. It is also called advanced prostate cancer.

If your prostate cancer has spread you might:

  • have bone pain
  • feel very tired (fatigue)
  • feel generally unwell
  • have weight loss for no known reason

You might have specific symptoms depending on where the cancer has spread to. These symptoms can also be caused by other medical conditions so might not be a sign that the cancer has spread.

You should contact your doctor if you're concerned about any symptoms.

Where does prostate cancer spread?

The most common place for prostate cancer to spread to is the bones. It can also spread to the:

  • lymph nodes Open a glossary item
  • liver
  • lungs

A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage, bladder or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.

Diagram showing prostate cancer pressing on the urethra

Symptoms of prostate cancer spread to the bones

The most common place for prostate cancer to spread to is the bones. This can include the:

  • spine
  • pelvis
  • ribs
  • skull
Diagram showing metastatic prostate cancer

The most common symptom if cancer has spread to the bone is bone pain. It is usually there most of the time and can wake you up at night. The pain can be a dull ache or stabbing pain.

Your bones might also become weaker and more likely to break (fracture).

When prostate cancer spreads to the spine, it can put pressure on the spinal cord Open a glossary item and cause spinal cord compression. This stops the nerves from being able to work properly. Back pain is usually the first symptom of spinal cord compression. 

Spinal cord compression is an emergency. You should contact your treatment team immediately if you are worried you might have spinal cord compression.

Symptoms of prostate cancer spread to the lymph nodes

Lymph nodes are part of a system of tubes and glands in the body that filters body fluid and fight infection. 

There are lots of lymph nodes in the pelvic area, which is close to the prostate gland. Prostate cancer can spread to the lymph nodes in the pelvic area, or to other parts of the body. The most common symptoms are swelling and pain around the area where the cancer has spread.

Diagram of prostate cancer that has spread to the lymph nodes

Cancer cells can stop lymph fluid from draining away. This might lead to swelling in the legs due to fluid build up in that area. The swelling is called lymphoedema.

Symptoms of prostate cancer spread to the liver

You might have any of the following symptoms if your cancer has spread to the liver:

  • discomfort or pain on the right side of your tummy (abdomen)
  • feeling sick
  • poor appetite and weight loss
  • a swollen tummy (called ascites)
  • yellowing of the skin and whites of the eyes (jaundice)
  • itchy skin

Symptoms if cancer has spread to the lungs

You may have any of these symptoms if cancer has spread to your lungs:

  • a cough that doesn’t go away
  • breathlessness
  • coughing up blood
  • a build up of fluid between the chest wall and the lung (a pleural effusion)

Symptoms of prostate cancer that has spread to or near the bladder

Large tumours in the prostate can press on the urethra and spread to the bladder. You might find that you:

  • pass urine more often
  • get up in the night to pass urine
  • have difficulty passing urine
  • have a strong urge to empty your bladder
  • have blood in your urine or semen

Symptoms of prostate cancer that has spread to the bowel

The rectum is part of the bowel that is close to the prostate. Prostate cancer can spread to the bowel, but it is rare. You might have:

  • constipation
  • pain in your tummy
  • blood in your poo or from your back passage

Symptom control team

There are symptom control teams in most cancer units. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.

Most symptom control teams have home care services so they can visit you at home.

How you might feel

When prostate cancer is advanced, it can no longer be cured. But treatment can control it for some time and help to relieve symptoms.

Finding out that your cancer can’t be cured is distressing and can be a shock. It’s common to feel uncertain and anxious. It's normal not to be able to think about anything else.

Lots of information and support are available to you, your family and your friends. It can help to find out more about your cancer and the treatments you might have. Many people find that knowing more about their situation can make it easier to cope.

Talk to your doctor or nurse to understand:

  • what your diagnosis means
  • what is likely to happen
  • what treatment is available
  • how treatment can help you
  • Cancer: Principles and Practice of Oncology (11th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Wolters Kluwer, 2019

  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2019. Last updated December 2021

  • Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    C Parker and others
    Annals of Oncology, 2020. Vol 31, Issue 9. Pages 1119-1134

  • Clinical features of patients who present with metastatic prostate carcinoma and serum prostate-specific antigen (PSA) levels < 10 ng/mL
    Alison J and others
    Cancer (American Cancer Society Journal), 2003. Vol 98, Issue 11. Pages 2362-2367

Last reviewed: 
20 Jul 2022
Next review due: 
20 Jul 2025

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