Your back hurts. You also urinate worse than you used to. And somewhere online you read that back pain can be a sign of prostate cancer.
Let me reassure you straight away, and then be honest about what is actually true.
Does an enlarged prostate cause back pain?
No. An enlarged prostate squeezes your urethra and therefore causes urinary symptoms: weak stream, frequency, getting up at night. Pain is not part of the picture, and back pain least of all. The prostate sits at the front of your pelvis, not against your spine.
If you have back pain and urinary symptoms, you most likely have two things at once. That is hardly strange at fifty. Back pain is simply one of the most common complaints there is.
The combination is coincidence. That sounds too simple, but it is usually exactly what is going on.
So what can actually hurt?
Inflammation of the prostate, not enlargement. In prostatitis and chronic pelvic pain syndrome, pain is very much front and centre: in the perineum (between scrotum and anus), the lower abdomen, the scrotum or the penis. Some men feel it low in the back or the tailbone too.
That is a different condition from BPH, with different causes and a different approach. We covered it separately in prostatitis: symptoms and causes.
Chronic pelvic pain is also not a single disease. It is now understood as a set of profiles, in which pelvic floor muscle tension, nerve irritation and stress all play a part (Polackwich, 2016). That explains why a course of antibiotics does nothing for many men.
When is back pain a reason to go quickly?
When it does not behave like ordinary back pain. Back pain that worsens at night, that keeps you from sleeping, that does not respond to posture or rest, or that comes with unintended weight loss or fever: do not wait on that. The same goes for weakness or tingling in your legs.
This has little to do with your prostate and a lot to do with the rule that persistent, night-time, non-mechanical pain always needs to be looked at.
| What you feel | What it more often points to | What to do |
|---|---|---|
| Nagging low back pain, worse bending or sitting long, better when moving. | Ordinary mechanical back complaints. By far the most common. | Keep moving, and see your GP if it lasts weeks. |
| Weak stream, frequency, up at night, no pain. | Benign prostatic enlargement. | Score yourself with the IPSS in the prostate guide and book a visit. |
| Pain in perineum, scrotum or lower abdomen, sometimes radiating to the back. | Prostatitis or chronic pelvic pain syndrome. | GP. This needs a different approach from BPH. |
| Fever, chills, pain on urinating. | An infection. | Get in touch the same day. |
| Back pain worsening at night, with weight loss or feeling generally unwell. | Something unrelated to BPH that needs assessment. | Book an appointment soon. Do not wait it out. |
But what about back pain and prostate cancer?
That link exists, and it is not what you think. Back pain can occur in advanced prostate cancer that has spread to bone. That is a late stage, and it virtually never presents as "I urinate a bit worse and my back aches". Dutch GP portal Thuisarts.nl says it flatly: urinary problems are not a sign of prostate cancer.
Early prostate cancer usually causes no symptoms at all. That is precisely what makes it difficult, and why the Dutch Gezondheidsraad does not recommend a national PSA population screening programme.
So your urinary symptoms do not argue for cancer. They argue for a prostate that has grown, which at your age is the most likely thing by far.
What to do with a PSA result
Nothing, on your own. A PSA value is raised by an enlarged prostate, by inflammation, after cycling and after sex. On its own it says little, and it belongs in a conversation with your GP.
Picture two men of 55 with exactly the same nagging back pain. One urinates fine and scores 3 on the IPSS. The other scores 18 and is up twice a night.
Only the second has a prostate story. The first simply has back pain, and that deserves its own appointment.
I think that is where most of the needless worry comes from: two separate complaints being added up into one fear.
How to read such a number is in PSA levels by age. The broader weighing up around testing is in prostate health, screening and prevention.
What you can do now
Split your complaints. Write down separately how you urinate (use the seven IPSS questions from the pillar) and separately how your back feels: when worse, when better, and whether anything about it you cannot explain.
Arrive at your GP with two clear stories rather than one vague one, and you get a better conversation.
If you are searching in the same area: bowel symptoms also get blamed on the prostate, and that link runs differently than you would think. See enlarged prostate and bowel symptoms. And if it is mainly your bladder keeping you awake, start with frequent urination at night.
References
- Polackwich AS, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome: a review of evaluation and therapy. Prostate Cancer Prostatic Dis. 2016;19(2):132-138. PMID 26951713.
- Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474-479. PMID 6206240.
- Barry MJ, Fowler FJ Jr, O'Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol. 1992;148(5):1549-1557. PMID 1279218.
- Thuisarts.nl. Plasklachten bij mannen. thuisarts.nl
- NHG. NHG-Standaard Mictieklachten bij mannen. richtlijnen.nhg.org
- Gezondheidsraad. Screening for prostate cancer. 2018. gezondheidsraad.nl
Every blood test result at Caliber includes a professional assessment by a BIG-registered doctor. For treatment decisions, always discuss your results with your GP.
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