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Bone metastases in men with prostate cancer are often initially asymptomatic, resulting in delayed identification, diagnosis, and appropriate treatment.To assess how patients with advanced prostate cancer (aPC) communicate symptoms to health care providers, an international patient survey was conducted.An online and phone survey was conducted by Harris Poll in 11 countries (Brazil, France, Germany, Japan, Italy, Netherlands, Singapore, Spain, Taiwan, United Kingdom, United States) from February 12 to October 27, 2015, in men with aPC (ie, those who reported as having PC beyond the prostate [metastatic]) and their caregivers.Cell weighting was used to ensure equal weight of data across countries. Percentages are based on weighted n values.A total of 927 men with aPC (weighted n = 664) and 400 caregivers completed the survey. Most commonly reported symptoms were fatigue (73%), urinary symptoms (63%), sexual function symptoms (62%), and bone pain (52%). Of 568 patients with bone metastases (weighted n = 421), most (73%) noticed pain before receiving a diagnosis of metastatic PC. Most patients with aPC (56%) were uncertain if their pain was cancer related, 55% felt they had to live with daily pain, 45% sometimes ignored pain, and 39% had difficulty talking about pain. Patients who had a caregiver were more likely than those without to discuss pain at every visit (45% vs. 32%, P < .05).Disease symptoms in aPC are often underrecognized. Tools encouraging effective communication among patients, caregivers, and health care providers on early symptom reporting may lead to enhanced symptom and disease management.An international survey was conducted in 927 men with advanced prostate cancer (aPC) and 400 caregivers to assess symptom communication. Patients with aPC often ignore pain and pain-related symptoms, do not discuss pain with their physician, and have difficulty discussing symptoms. Effective communication among patients, caregivers, and health care providers may improve symptom and disease management and patient quality of life.