What are BPH and prostate cancer?
Both benign prostatic hyperplasia (BPH) and prostate cancer affect the prostate gland. The prostate is a walnut-sized gland that sits below a man’s bladder. It makes the fluid part of semen. The prostate wraps around the urethra. This is the tube that carries urine from the bladder out of the body.
In both BPH and prostate cancer, the prostate gland gets larger. BPH is benign. This means it’s not cancer and it can’t spread. Prostate cancer can spread to other parts of your body.
What are the symptoms of BPH and prostate cancer?
BPH and prostate cancer have similar symptoms, so it’s sometimes hard to tell the two conditions apart. As the prostate grows for any reason, it squeezes the urethra. This pressure prevents urine from getting down your urethra and out of your body. Prostate cancer symptoms often don’t start until the cancer has grown large enough to put pressure on the urethra.
Symptoms of both BPH and prostate cancer include:
- an urgent need to urinate
- feeling the urge to urinate many times during the day and night
- trouble starting to urinate or having to push to release urine
- weak or dribbling urine stream
- urine flow that stops and starts
- feeling like your bladder is never fully empty
If you have prostate cancer, you might also notice these symptoms:
- painful or burning urination
- blood in your urine
- trouble getting an erection
- painful ejaculation
- less fluid when you ejaculate
- blood in your semen
What causes each condition?
A man’s prostate naturally grows as he gets older. Doctors don’t know the exact reason for this growth. Changing hormone levels might trigger it.
All cancer starts when cells start to multiply out of control. Cancer is caused by changes to DNA, the genetic material that controls cell growth. You can inherit DNA changes from your parents. Or these changes can develop during your lifetime.
What are the risk factors?
A few other factors can increase your risk for BPH and prostate cancer, including:
- Your race: BPH and prostate cancer are more common in African-American men than in Asian-American men.
- Your family history: Both of these conditions run in families. You’re more likely to get BPH or prostate cancer if a male relative has it. If your father or brother had prostate cancer, your risk of getting the disease more than doubles.
- Your weight: Being obese increases your risk for BPH. It’s not clear how weight influences prostate cancer, but research has shown a correlation between increased BMI and incidence of cancer, including prostate cancer.
Other risks for BPH include:
- Your other health conditions: Having diabetes or heart disease could make you more likely to get BPH.
- Your medicines: Blood pressure-lowering drugs called beta-blockers might affect your BPH risk.
Other risks for prostate cancer include:
- Your location: Men who live in North America and Western Europe are at higher risk than those in Asia, Africa, Central America, and South America. Your risk of dying from prostate cancer is highest if you live in a northern area, such as Boston or Ohio. This may be due to low levels of vitamin D. Your skin produces this vitamin when it’s exposed to the sun.
- Environmental exposures: Firefighters work with chemicals that might increase their risk. Agent Orange, a weed killer used during the Vietnam War, has also been linked to prostate cancer.
- Your fitness: Exercise may reduce your risk for prostate cancer.
- Your diet: Food doesn’t seem to directly cause prostate cancer. Yet eating too few vegetables may lead to a more aggressive form of the disease.
How is each condition diagnosed?
You’ll see a specialist called a urologist to diagnose BPH or prostate cancer. Doctors use many of the same tests to diagnose both of these conditions.
- Prostate-specific antigen (PSA) test: This blood test detects PSA, a protein your prostate gland makes. When your prostate grows, it produces more of this protein. A high PSA level can only tell your doctor that your prostate has grown. It can’t tell for sure that you have BPH or prostate cancer. You’ll need more tests to confirm the diagnosis.
- Digital rectal exam (DRE): Your doctor will insert a gloved, lubricated finger into your rectum. This test can show if your prostate is enlarged or abnormally shaped. You’ll need more tests to find out if you have BPH or prostate cancer.
Tests to diagnose BPH
Your doctor can use these other tests to confirm that you have BPH:
- A urinary flow test measures the speed of your urine flow.
- A post-void residual volume test measures how much urine is left in your bladder after you urinate.
Tests to diagnose prostate cancer
These tests can confirm a prostate cancer diagnosis:
- Ultrasound uses sound waves to make pictures of your prostate gland.
- A biopsy removes a sample of prostate tissue and checks it under a microscope for cancer.
How are BPH and prostate cancer treated?
Which treatments you get for BPH depend on the size of your prostate and how severe your symptoms are.
For mild to moderate symptoms, your doctor might prescribe one of these medicines:
- Alpha-blockers relax muscles in your bladder and prostate to help you urinate more easily. They include alfuzosin (Uroxatral), doxazosin (Cardura), and tamsulosin (Flomax).
- 5-alpha reductase inhibitors shrink your prostate. They include dutasteride (Avodart) and finasteride (Proscar).
Doctors use surgery to treat severe BPH symptoms:
- Transurethral resection of the prostate removes only the inner part of the prostate.
- Transurethral incision of the prostate makes small cuts in the prostate to allow urine to pass through it.
- Transurethral needle ablation uses radio waves to burn off extra prostate tissue.
- Laser therapy uses laser energy to remove excess prostate tissue.
- Open prostatectomy is only done if your prostate is very large. The surgeon makes a cut in your lower belly and removes prostate tissue through the opening.
Treatments for prostate cancer include:
- Active surveillance or watchful waiting: You don’t get treated right away. Instead, your doctor watches your symptoms or does regular DRE and PSA tests to check for cancer growth.
- Surgery: A procedure called a radical prostatectomy removes the prostate gland and some of the tissue around it.
- Radiation therapy: Radiation uses high-energy X-rays to destroy prostate cancer. You’re exposed to radiation from a machine outside your body. Or you can get it through small radioactive pellets or seeds placed inside your prostate.
- Cryotherapy: This treatment uses intense cold to destroy prostate tissue.
- Hormone therapy: You take medicine to block the male hormones that fuel the growth of prostate cancer.
What’s the outlook?
Treatments should improve BPH symptoms. You might have to keep taking the same medicine or go on a new treatment to prevent your symptoms from coming back. Surgery and other BPH treatments can have side effects such as trouble getting an erection or urinating.
The outlook for prostate cancer depends on the stage of your cancer, or whether it has spread, and how far. When treated, the five-year survival rate for all stages of prostate cancer is almost 100 percent compared to men without this cancer. That means that when you eliminate other factors not related to prostate cancer, close to 100 percent of men who are diagnosed and treated for prostate cancer are still living five years after treatment.
How often should you be screened?
If you’ve already been diagnosed with BPH or prostate cancer, see your doctor for regular follow-ups. Although routine screening isn’t recommended for prostate cancer, you might want to get screened with a DRE or PSA test based on your age and risks. Ask your doctor whether it’s worthwhile for you to get screened, and what tests you should have.