Physical Exam

Physical exam findings and signs exhibited by patients with prostate cancer will vary according to the individual, but generally include the following

• Weak urinary stream
• Frequent and/or urgent urination, especially at night
• Difficulty starting or stopping the urinary stream
• Incomplete emptying of the bladder
• Painful burning urination
• Blood in the urine or semen
• Painful ejaculation
• Pain or stiffness in the lower back, hips, or upper thighs (advanced prostate cancer)
• Shortness of breath, feeling very tired, fast heartbeat, dizziness, or pale skin caused by anemia (advanced prostate cancer)

Other conditions may cause the same problems above, including Benign Prostatic Hyperplasia (BPH). As men age, the prostate may get bigger and block the urethra or bladder. This may cause trouble urinating or sexual problems. It is not cancer, although surgery may be done to alleviate the symptoms.

A common procedure done for BPH is a Transurethral Resection of the Prostate (TURP). In this procedure, a resectoscope is placed through the tip of the penis and then through the urethra. This scope helps the physician to see the prostate and remove any excess tissue.

• Incidental findings of prostate cancer often occur in TURPs performed for BPH or LUTs.
• TURP’s do not remove the entire prostate but only the segments that are causing urinary obstruction. Thus, a patient who undergoes a TURP for BPH can still develop prostate cancer at a later time in the remaining prostate tissue.

Also, during the physical exam, a digital rectal examination (DRE)may be done. The prostate can be felt through the rectal wall, and during this exam, the physician is feeling the rectal wall for any lumps or abnormal areas.

For many years, the digital rectal examination (DRE) was the gold standard for assessing the clinical stage for prostate cancer. With advancing imaging techniques, MRI guided biopsies are now being used to diagnose and stage cancer patients.

See EOD Primary Tumor for coding the results of the DRE (if done).

Document physical exam details in NAACCR Item #2520 Text-Dx Proc-PE.

See History & Physical Exam | SEER Training website for more information on the patient history and physical exam.

Updated: June 15, 2026