Prostate Cancer Pain: How common, causes, and care

Pain can occur with prostate cancer, but how common it is depends on the stage and where the cancer has spread. ^[1] Pain in the back, hips, pelvis, or bones is more likely when the cancer advances or metastasizes (spreads), especially to the skeleton. ^[2] Bone pain and pelvic pain are typical symptoms in metastatic disease, and they often worsen over time. ^[3] Frequent urination or trouble starting urine are more often due to benign prostate enlargement rather than cancer. ^[1]

How common is pain in prostate cancer?

• Early or localized prostate cancer may cause few or no symptoms, and pain is not typically prominent at this stage. ^[1]
• As cancer grows or spreads, pain becomes more common, often felt in the lower back, hips, pelvis, or other bones. ^[2]
• Persistent or progressive bone pain is a hallmark of metastatic (stage 4) disease. ^[3]

What causes the pain?

• Bone metastases: Prostate cancer frequently spreads to bones, leading to structural weakness, inflammation, and nerve irritation, which produces deep, aching pain that can worsen with movement or at night. ^[3]
• Local pelvic involvement: Tumor growth in the prostate and surrounding pelvic tissues can cause pelvic pain and painful ejaculation or urinary burning. ^[2]
• Nerve involvement: Cancer interacting with nerves in and around bone and pelvic tissues can drive persistent pain through sensitization of sensory nerves. [PM19]
• Treatment side effects or comorbid conditions: Some urinary pain symptoms may reflect non-cancer causes like benign prostate hyperplasia, even in men who also have cancer. ^[1]

Related symptoms to watch

• Ongoing pain in the back, hips, pelvis, or upper thighs can be associated with advancing prostate cancer and warrants medical evaluation. ^[2] Pain may accompany other signs such as weight loss, fatigue, and urinary symptoms in metastatic disease. ^[4]

Evidence-based pain management

Pain control is best approached in layers, combining medicines, local treatments, and supportive care tailored to the cause and severity. ^[5]

Medicines (analgesics)

• Stepwise pain control: Using a structured approach (often called the analgesic ladder), starting with non-opioid pain relievers and adding opioids for moderate to severe pain when needed, with regular reassessment to optimize relief and minimize side effects. ^[6]
• Opioids and NSAIDs: These are central options for bone pain control when taken as directed and monitored for safety. [PM13]

Local radiation therapy

• External-beam radiation (EBRT): Targeted radiation to painful bone metastases can provide substantial relief; commonly used schedules include single 8 Gy or multi-fraction courses such as 20 Gy in 5 fractions or 30 Gy in 10 fractions, selected based on goals and clinical context. ^[7]
• Stereotactic body radiation therapy (SBRT): Considered for selected spinal and non-spinal lesions to improve pain and local control; recommendations vary with site and fracture risk. ^[8] Conditional recommendations exist for non-spinal sites with attention to life expectancy and disease burden. ^[9]

Radiopharmaceuticals (systemic bone-targeted radiation)

• Bone-seeking agents: Medications like strontium-89 or similar agents concentrate in bone metastases and can reduce pain in a majority of cases, with onset in about 1–3 weeks and benefits lasting months; monitoring for blood count suppression is important. [PM16] Clinical experience has shown pain relief in many people with metastatic prostate or breast cancer, with generally reversible marrow effects. [PM17]

Systemic prostate cancer therapies

• Androgen-targeted therapies and chemotherapy: Treatments such as abiraterone, enzalutamide, docetaxel, and others can reduce tumor burden, delay skeletal complications, and indirectly reduce pain as disease is controlled. [PM13]
• Bone-protective agents: Bisphosphonates (e.g., zoledronate) and denosumab help reduce skeletal events and may contribute to pain reduction by strengthening bone and stabilizing lesions. [PM13]

Supportive and non-drug options

• Palliative care involvement: A supportive care team focuses on whole-person symptom relief, coordinating medications, procedures, and coping strategies to improve comfort and quality of life. ^[5]
• Complementary therapies: Techniques like acupuncture, acupressure, massage, relaxation strategies, and hypnosis can be added to reduce pain and stress when medically appropriate. ^[10] These methods can support standard medical treatments and help some people feel better day to day. ^[11]
• Rehabilitation and physical modalities: Tailored physical therapy and rehabilitative strategies can ease cancer-related pain, improve mobility, and reduce disability in collaboration with oncology and pain specialists. ^[12]

When to seek medical help

• New, persistent, or worsening pain in the back, hips, pelvis, or any bone should be evaluated promptly, especially if you have a history of prostate cancer or risk factors. ^[3] If pain medicines are not controlling your symptoms, ask for a comprehensive pain review; a pain specialist may offer additional options. ^[13]

Practical tips for managing pain day to day

• Track your pain and share specific details (location, timing, what helps or worsens it) to guide treatment adjustments. ^[5]
• Use scheduled dosing for pain medicines when advised, rather than waiting for severe pain, to maintain steadier control. ^[6]
• Combine approaches: medicines, local radiation, bone-targeted treatments, and supportive therapies often work best together to achieve meaningful relief. ^[5]