Thanks to PSA testing, most prostate cancers are now found before they cause symptoms. Although most of the symptoms listed below can occur with prostate cancer, they are more likely to be associated with noncancerous conditions.

• Urinary hesitancy (delayed or slowed start of urinary stream)
• Urinary dribbling, especially immediately after urinating
• Urinary retention
• Pain with urination
• Pain with ejaculation
• Lower back pain
• Pain with bowel movement

Other symptoms that may occur with this disease:

• Excessive urination at night
• Urinary leakage (incontinence)
• Bone pain or tenderness
• Blood in the urine (hematuria)
• Abdominal pain
• Low red blood cell count (anemia)
• Unintentional weight loss
• Lethargy

A rectal exam will often show an enlarged prostate with a hard, irregular surface.

A number of tests may be done to diagnose prostate cancer:

• PSA test (may be high, although noncancerous enlargement of the prostate can also increase PSA levels)
• Free PSA (may help tell the difference between BPH and prostate cancer)
• AMACR (a newer test that is more sensitive than the PSA test for determining prostate cancer)
• Urinalysis (may show blood in the urine)
• Urine or prostatic fluid testing (may reveal unusual cells)

Prostate biopsy is the only test that can confirm the diagnosis.

The following tests may be done to determine whether the cancer has spread:

• CT scan
• Bone scan
• Chest x-ray

Health care providers use a system called staging to describe how far the cancer has grown. Tumor size, and how far the cancer has spread outside of the prostate determine the stage. Identifying the correct stage may help the doctor recommend the best treatment.

There are several different ways to stage tumors, including:

• The TNM staging system (most common)
• The A-B-C-D staging system, also known as the Whitmore-Jewett system

The grade of a tumor describes how aggressive a cancer might be. The more tumor cells differ from normal tissue, the faster these cells are likely to grow. The grading system for prostate cancer is called the Gleason grade or score. Higher scores are usually faster growing cancers.