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Enlarged Prostate Versus Prostate Cancer: What's the Difference?

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Posted by Justin I. Friedlander, MD

In my urology practice, prostate concerns are one of the top issues brought up by my patients. Many experience symptoms that they worry could be prostate cancer, but they're often affected by something called benign prostatic hyperplasia, or BPH.

A common condition affecting some 14 million U.S. men, BPH can, at first, look a lot like prostate cancer — but it's not related. 

I reassure my patients that simply having an enlarged prostate does not mean that they have prostate cancer. And being diagnosed with BPH does not indicate a higher risk of developing prostate cancer later on. 

However, because the two conditions appear to be similar, BPH symptoms can cause stress and anxiety for patients and their families. Therefore, I like to walk individuals through the two conditions and explain how they are different.

Here's what I like patients to know about both — and why they shouldn't be worried about getting diagnosed with BPH.

BPH versus prostate cancer

The prostate is a small gland in the male reproductive system. Located just below the bladder, the prostate's primary job is to produce fluid that mixes with sperm to make semen. 

It's not uncommon to experience changes to the prostate as a person gets older. One of these is BPH, or an enlarged prostate, where the prostate slowly grows bigger. BPH can increase pressure on the bladder and affect urination. The condition is not cancerous and, in some cases, doesn't require treatment of any kind.

Prostate cancer, on the other hand, occurs when cancerous cells form in the tissues of the prostate. Many prostate cancers grow very slowly and can sometimes be managed with active surveillance. Other cases may require aggressive treatment, such as chemotherapy, radiation therapy, or surgery.

The two conditions are not related, but some patients with BPH may worry about the possibility that they have prostate cancer. Why? It often comes down to the symptoms. Both can cause problems with urination that can gradually worsen, such as:

Some symptoms set prostate cancer apart though. These include a nagging pain in the back, hips, or pelvis and fecal incontinence

What causes BPH?

Another concern many patients have about BPH is that it involves growth in the prostate, which initially may sound similar to prostate cancer. But there's an important difference: Prostate cancer is fueled by the growth of abnormal (cancerous) cells. With BPH, it's simply normal, healthy prostate cells that are growing larger.

The growth that occurs with BPH results from aging, genetics, and changing levels of hormones such as testosterone, estrogen, and dihydrotestosterone (DHT). In fact, it's completely normal for the prostate to get bigger over time. By age 40, the prostate has typically grown from the size of a walnut to the size of an apricot. By age 60, the prostate has reached the size of a lemon.  

Who is at risk?

Anyone with a prostate can develop BPH or prostate cancer. There are risk factors that can increase an individual's chances for either condition, but they aren't identical. 

BPH is most common after age 40. The risk for the condition rises if a person has:

Prostate cancer is most common after age 50, but because it's often very slow-growing, the symptoms may not be noticed until decades later. While it can affect anyone with a prostate, it's more common among African Americans. Like BPH, the risk for prostate cancer is higher if it runs in a person's family.  

I always encourage my patients to share their health histories and lifestyle habits. A solid understanding of these factors can help us determine which urologic conditions a patient might be more likely to develop and devise a plan to screen for possible symptoms. 

BPH or prostate cancer: How to know the difference

Though BPH and prostate cancer are entirely distinct conditions with different causes, the two conditions have similar symptoms. It's crucial to see a doctor for a thorough workup to determine the correct diagnosis.

I'll typically conduct a digital rectal exam of the prostate, where a gloved finger is inserted into the rectum to feel if the prostate is tender or unusually large and to detect other irregularities. I may also order a urine test, a blood test, imaging, or tests to see how well the patient can hold or release urine. 

If the results aren't definitive, I'll conduct a prostate biopsy to confirm or rule out prostate cancer. During a biopsy, a small piece of tissue is removed from the prostate and checked for cancerous cells. 

If a patient is found to have BPH, I emphasize to them that the condition is often harmless and may not require treatment. However I still like to monitor a patient's enlarged prostate and stay up-to-date on symptoms. In rare instances, BPH can lead to complications such as urinary retention, urinary tract infections, bladder or kidney damage, or bladder stones.

Treatment for BPH

Some patients opt to forego treatment for BPH if their symptoms aren't bothersome. If an enlarged prostate affects a patient's quality of life, treatment can help. Options may include:

  • Lifestyle changes: Simply cutting back on liquids (especially alcohol or caffeine) before going out or going to sleep can reduce disruptive bathroom runs. Training the bladder to hold urine for longer stretches or practicing pelvic floor exercises may also be helpful. 
  • Medications: Prescription drugs can shrink or stop the prostate from growing. Other medicines may help relax the pelvic floor muscles to make urine flow easier. I'll typically recommend alpha blockers, phosphodiesterase-5 inhibitors, 5-alpha reductase inhibitors, or combination medications. 
  • Minimally invasive procedures: Procedures to destroy enlarged prostate tissue or widen the urethra can remove blockages and make urine flow easier. We may move on to these options if lifestyle changes or medications aren't making enough difference. We offer procedures not offered at many local health systems, like Aquablation and HoLEP.
  • Surgery: When a patient's symptoms are severe or have caused bladder damage, a patient and I may discuss surgery to remove part or all of the prostate or make cuts in the prostate to make the urethra wider. 

Get answers about prostate problems

BPH and prostate cancer share many symptoms, but that's where their similarities end. The correct diagnosis often eases my patient's minds — and treatment eases disruptive symptoms. Don't delay. If you or a loved one are experiencing problems with urination or related concerns, schedule an appointment with a Fox Chase-Temple Urologic Institute urologist today. Call 800-TEMPLE-MED (800-836-7536) or request an appointment online.  

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Justin I. Friedlander, MD

Dr. Friedlander is a Endourologist who specializes in the surgical management and medical prevention of kidney stones and treatment of benign prostate enlargement with Holmium laser enucleation of the prostate (HoLEP). 

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