Prostate Cancer Symptoms: 12 Signs Men Often Miss (and Why Most Men Have None)

Medically reviewed by Mr Maneesh Ghei, Consultant Urological Surgeon (GMC: 5208045)

Prostate cancer symptoms in the early stages are usually absent, which is the single most important fact every UK man needs to know. When symptoms do appear they tend to involve urinary changes, blood in the urine or semen, sexual dysfunction or in advanced disease, bone pain – by the time symptoms are obvious, the cancer has often grown beyond the prostate itself.

Jeremy Clarkson made this point in his announcement of an aggressive prostate cancer diagnosis on Clarkson’s Farm in June 2026. He had no symptoms and a PSA blood test caught it early and without that test his outcome would have been very different. This post lists the 12 warning signs that should prompt a Urologist visit and explains why men with none of them still need to test.

Why Most Early Prostate Cancers Have No Symptoms

The prostate sits below the bladder and wraps around the urethra, so symptoms only appear when the gland grows large enough to press on the urethra, when cancer cells invade nearby structures or when disease spreads beyond the prostate.

Most prostate cancers start in the peripheral zone which is the outer part of the gland, well away from the urethra. A tumour in this area can grow for years without affecting urine flow at all – this is why a man can feel completely well and still have an aggressive cancer growing.

By the time urinary symptoms appear, 2 things are likely – either the prostate has enlarged due to a benign condition (BPH or prostatitis) or a cancer has grown large enough or moved far enough that early stage treatment is no longer the only option. The earlier you find it, the wider the range of treatments available to you.

The 12 Prostate Cancer Symptoms Men Often Miss

These symptoms can be caused by prostate cancer, by an enlarged prostate (BPH), by prostatitis or by other urinary conditions, and any of them in a man over 50 warrants a PSA test and a urology consultation. Most will turn out to be benign but the only way to know is to investigate:

1. Weak or interrupted urinary stream

A urinary stream that has lost force, splits, sprays or stops and starts mid-flow can indicate prostate pressure on the urethra and often the first thing a man notices is needing to angle differently or wait longer for flow to begin.

2. Difficulty starting urination

Hesitancy at the start of urination, sometimes needing 10 to 20 seconds to begin flow even when the bladder feels full and often more pronounced first thing in the morning.

3. Frequent urination, especially at night

Getting up more than twice a night to urinate (nocturia) or needing to go again within an hour of last urinating during the day. This is one of the most commonly reported symptoms but is usually due to BPH rather than cancer.

4. Urgency

A sudden, intense need to urinate that is difficult to defer – some men describe near-misses on the way to the toilet. Urgency can indicate prostate pressure, an overactive bladder or, less commonly, cancer of the bladder neck.

5. Feeling of incomplete emptying

A persistent sensation that the bladder has not emptied fully, often leading to a second trip to the toilet within minutes – this can also cause recurrent urinary tract infections.

6. Dribbling after urination

Post-void dribbling that lingers for several seconds or minutes after you think you have finished – easy to dismiss as embarrassing rather than significant, however it is a clear sign of altered prostate or pelvic floor function.

7. Blood in the urine (haematuria)

Any visible blood in the urine, even a single occurrence, needs urgent assessment. Most cases are caused by infection or stones but bladder cancer, kidney cancer and prostate cancer are all on the list of possibilities. Read our guide on blood in urine and what it means.

8. Blood in the semen (haematospermia)

Pink, brown or red discolouration of the ejaculate – often benign and self-limiting, however in men over 40 it is worth a PSA test and urology review to exclude prostate pathology.

9. Erectile changes

New onset of erectile dysfunction, particularly in a man who previously had no issues. Prostate cancer rarely causes ED directly until advanced stages, however underlying vascular changes and BPH-related medications can both contribute.

10. Painful ejaculation

Pain or burning during or immediately after ejaculation – most commonly caused by prostatitis but in an older man with no prior history, it warrants a full assessment.

11. Pelvic, lower back or hip pain

Persistent dull ache or pain in the pelvis, lower back or hips that does not improve with rest or simple analgesia. In advanced prostate cancer this can indicate spread to nearby tissues or the pelvic bones.

12. Unexplained weight loss or fatigue

Losing weight without trying, persistent fatigue or a general sense of feeling unwell over weeks to months. These are non-specific symptoms but combined with any urinary changes, they warrant prompt investigation.

Why “I Feel Fine” Is Not Enough

The single biggest reason UK men are diagnosed with prostate cancer at later stages is that they do not test when they feel well. Around 47,000 men are diagnosed with prostate cancer in the UK each year and unfortunately around 12,000 die from it. The largest difference between survivors and non-survivors is the stage at diagnosis and the stage at diagnosis is determined by when you test.

Jeremy Clarkson’s diagnosis is a useful illustration – he was 66 with no symptoms, however his PSA test picked up a cancer his MRI then confirmed and his biopsy then graded. Without that test, he has said that this would likely have been his last farming harvest. He is not unique – every private urology clinic in London sees men in their fifties and sixties who feel completely well and turn out to have early-stage cancer.

Are These Symptoms Always Cancer?

No – most of the symptoms on this list are far more commonly caused by benign conditions:

• Benign prostatic hyperplasia (BPH) – age-related enlargement of the prostate which affects around half of men over 60
• Prostatitis – inflammation of the prostate, often presenting with painful urination, painful ejaculation and pelvic discomfort
• Urinary tract infection – more common in older men due to incomplete bladder emptying
• Bladder conditions – including overactive bladder, bladder stones and bladder cancer
• Pelvic floor dysfunction – often related to chronic constipation, prolonged sitting or previous surgery

A urology consultation distinguishes between these – the PSA test, digital rectal examination and, where needed, multiparametric MRI give the Urologist enough information to identify what is causing your symptoms and recommend the right treatment.

Who Is Most At Risk Of Prostate Cancer?

Risk rises sharply with age and is also affected by inherited genetic risk and family history, and ethnicity.

If you fall into any of these higher-risk groups, you should test earlier and more often than the population average.

When Should You See A Urologist?

See a Urologist if:

• You are aged 50 or over and have never had a PSA test
• You are aged 45 or over and have a family history of prostate, breast, ovarian or pancreatic cancer
• You are Black and aged 45 or over
• You have any urinary symptom from the 12 above that has lasted more than 2 weeks
• You have visible blood in the urine or semen, at any age, on even a single occasion
• You have unexplained pelvic, lower back or hip pain
• You have a previously raised PSA that has not been followed up
• You want a baseline PSA reading you can track over time

For more clinical detail on the symptoms and signs to look out for, the NHS prostate cancer symptoms page is a good complementary read.

What To Expect At Your First Urology Appointment

A first private appointment at Urocare London runs to 30 to 45 minutes, where Mr Ghei reviews your full history, examines you where clinically appropriate and arranges any tests on the day. A PSA test is usually performed at the same visit with the result following in 2 to 3 working days, and if further investigation is needed an MRI can usually be arranged within 1 to 2 weeks. Any biopsy or treatment is planned with you personally rather than handed to another team.

Frequently Asked Questions

What are the first signs of prostate cancer?

Most early prostate cancers cause no symptoms at all, and when symptoms do appear they usually involve a weaker or interrupted urinary stream, more frequent night-time urination, urgency, hesitancy starting to urinate or a feeling of incomplete bladder emptying. The only reliable way to catch prostate cancer at an early stage is with a PSA blood test.

Can you have prostate cancer with no symptoms?

Yes. Most prostate cancers begin in the peripheral zone of the gland, away from the urethra, so a tumour can grow for years without affecting urine flow. Jeremy Clarkson, whose June 2026 diagnosis brought new public attention to prostate cancer, had no symptoms before his PSA test detected it – this is the most common pattern.

Are prostate cancer symptoms different from BPH?

Many urinary symptoms overlap between prostate cancer and benign prostatic hyperplasia (BPH), and a weak stream, hesitancy and nocturia are far more often caused by BPH than by cancer. The difference is impossible to determine from symptoms alone – a PSA test, digital rectal examination and, if needed, MRI are required to tell them apart.

Does blood in semen mean prostate cancer?

Blood in semen (haematospermia) is most often caused by minor infection or inflammation and resolves on its own, however in men over 40 a single episode warrants a PSA test and urology review to exclude prostate pathology. Recurrent episodes always need investigation.

At what age should men start checking for prostate cancer?

UK guidance recommends a baseline PSA test from age 50 for all men, from age 45 if you have a family history of prostate, breast, ovarian or pancreatic cancer, from age 45 if you are Black, and from age 45 if you carry a BRCA2 mutation. Any man with urinary symptoms should test at any age.

How quickly does prostate cancer progress?

The rate of progression depends on the Gleason grade – low-grade cancers (Grade Group 1) often grow so slowly they may never become clinically significant, while intermediate and high-grade cancers (Grade Groups 3, 4 and 5) can progress over months to a few years.

What does an enlarged prostate feel like?

An enlarged prostate (BPH) typically causes a weaker urine stream, hesitancy starting urination, dribbling at the end, frequent urination especially at night and a feeling of incomplete emptying, and these symptoms are usually slow to develop. A PSA test and ultrasound or MRI confirm prostate size and rule out other causes including cancer.

About the Author

This article is for informational purposes only and does not constitute medical advice. If you have concerns about your prostate health, please consult a qualified medical professional.

Mr Maneesh Ghei, Consultant Urological Surgeon (GMC: 5208045)

Mr Maneesh Ghei is a consultant urological surgeon with NHS and private practice across four London hospitals. He specialises in the diagnosis and management of prostate conditions including BPH, prostatitis and prostate cancer, as well as urinary symptoms, kidney stones and male sexual health. Mr Ghei sees new patients privately with same-week availability. Both self-funded and insured patients are welcome. No GP referral is required. Book a prostate screening consultation.