In most cases, there are no clear clinical symptoms of prostate cancer. Prostate cancer is often slow-growing and its clinical symptoms are mostly similar to those of prostate enlargement, so it is often mistaken for having enlarged prostate (BPH). When the disease progresses more rapidly, you may experience fatigue, weight loss, and generalized pain. When there are bone metastases, pain in the corresponding area or pathological fractures may occur. The nature of bone pain varies from person to person. It can manifest as persistent pain or as intermittent pain. This bone pain may be confined to a specific area or may travel throughout the body. If there is significant bone destruction in the bone metastases, fractures may occur. The more common sites of skeletal metastases are the bones of the hip, back, thoracic ribs and shoulder. Some metastases can also be found in the bones and joints, so the site of bone metastases from prostate cancer is variable, as is the location of bone pain. Metastases to lymph nodes in prostate cancer are often asymptomatic. In rare cases, only extensive lymph node metastasis may result in edema in both limbs. Metastases to the spine can cause paraplegia due to fractures caused by damage to the bone or the tumor itself invading the spinal cord. When prostate cancer invades the base of the bladder or has extensive pelvic lymph node metastases, one or both ureters may be obstructed. Ureteral obstruction may be manifested by decreased urine output. If both ureters are involved, it may manifest as anuria, back pain, malignant vomiting, and fever if secondary to infection. Hematuria and hematuria are often not associated with prostate cancer, however, if you experience such symptoms, we recommend that you visit your regular urology clinic. Patients with extensive metastatic prostate cancer can also present with bleeding and may even develop anemia. This anemia may be related to the extensive metastases in the bones, hormone therapy, and the duration of the disease. Because of this slow rate of blood loss, there is often no discomfort. Some patients may present with clear signs of anemia such as weakness, postural hypotension, dizziness, shortness of breath and fatigue.