Is Pain a Sign of Prostate Cancer?

Reviewed by: HU Medical Review Board | Last reviewed: December 2023

Pain can be a sign of advanced prostate cancer. This pain may occur when prostate cancer has spread to the bones or other organs. Advanced prostate cancer can cause pain in areas such as the hips, back, ribs, or groin. It is often described as a dull, deep pain, potentially similar to a toothache, and is typically different from pain caused by sore muscles.1-4

Other prostate-related conditions also can cause pain. For example, the prostate can swell (prostatitis) due to a bacterial infection and can be painful. Benign prostatic hyperplasia is the enlargement of the prostate gland, which can be due to aging. It is not cancerous, but it can also lead to pain.3,5

How can prostate cancer cause pain?

When prostate cancer spreads, it often spreads to the bones. When this happens, it can lead to bone pain or other bone-related issues.6

Typically, your body maintains a careful balance of building and breaking down bones to keep them strong and healthy. When cancer spreads to the bones, it can disturb this process. This can cause the bones to become weak and become more likely to break or fracture, resulting in pain.6

Prostate cancer also can affect the nerves in the bones that send messages to the brain. When cancer damages the nerves, those nerves can send pain signals to the brain. This type of pain is called neuropathic pain.2,6

How can prostate cancer-related pain be treated?

Depending on the underlying cause, pain from advanced prostate cancer can be mild to severe. But there are treatment options that can reduce pain and improve quality of life.2,7

Medicines

Pain-relieving drugs can help manage pain due to bone cancer. The kind of pain reliever used depends on several factors, including how high your pain levels are. Pain-relieving drugs should be taken based on instructions given by your doctor. They may be either over-the-counter or prescription drugs.2,7,8

Other types of prescription drugs also can help relieve pain caused by cancer spreading to the bones. Bisphosphonates are a type of drug that can slow down damage to the bones due to cancer. Zoledronic acid (Zometa®) is a commonly used bisphosphonate in this scenario. Denosumab (Xgeva®) is a different type of drug that also aims to slow down bone damage.3,7

Steroid drugs (corticosteroids) are often used to reduce inflammation or swelling. They can also be used to treat bone pain. Common corticosteroids used to treat bone pain as a result of prostate cancer include prednisone and dexamethasone.7

Finally, radiopharmaceuticals may be used to kill cancer cells in the bones. These drugs contain radioactive elements. Once injected, they go to the cancer cells in places of bone damage and release radiation, which kills the cancer cells and can help reduce pain.7

Radiation therapy

Radiation therapy involves using high-energy X-ray beams to shrink cancerous tumors. It can be used to target prostate cancer tumors that have spread to the bones. This can lead to pain relief, which can improve quality of life.6,7

Surgery

Surgery is typically an uncommon method of treating bone pain. Your doctor might recommend surgery if cancer is causing your bones to fracture or break. In this case, surgery may help stabilize the bones. Special cement, metal pins, or metal plates can be inserted into the bones to make them stronger. Surgery may be followed by radiation therapy to stop the cancer from coming back in that spot.2,7

Other treatments

Less common treatments may include transcutaneous electrical nerve stimulation (TENS) therapy or nerve-blocking injections. TENS therapy uses a machine to send electrical signals to the nerves that may block pain signals. Nerve-blocking injections are used to reduce pain in a specific part of the body.2

Talk with your doctor about any pain you are feeling. They will ask you questions about the pain and run tests to find the cause of the pain. Depending on the cause, several treatment options may be available.3

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