Quick Highlights
- BPH is a benign condition, whereas prostate cancer is malignant.
- Symptoms of both these conditions can overlap, but cancer may also have blood in urine/semen, weight loss, or bone pain.
- PSA (Prostate-Specific Antigen levels can increase due to both BPH and prostate cancer. So a high PSA does not automatically mean cancer. It must be interpreted with other clinical findings.
- Risk factors for prostate cancer include age, family history, race, and genetics and not BPH itself.
- Regular screening is important is important for early detection, regardless of prostate size.
Changes in urinary habits or prostate health can understandably raise concerns. However, many symptoms, such as frequent urination or difficulty starting urination, are common in benign conditions like an enlarged prostate (BPH) and don’t necessarily indicate cancer. In this article, Dr Shalabh Agrawal, a leading urologist in Gurgaon, explains how an enlarged prostate differs from prostate cancer and what signs to watch for.
What is an enlarged prostate(BPH) and prostate cancer?
Prostate enlargement (BPH) is a condition that causes the prostate to grow. It majorly affects older men over the age of 50 years. Nonetheless, BPH can begin developing in a man starting from the age of 40.
Prostate cancer is a condition that leads to the growth and spread of cancer cells in the prostate. This cancer can affect any man at any age
Link Between Enlarged Prostate(BPH) and Prostate Cancer
Similarities
- Age-related conditions: Both BPH and prostate cancer are more common in men over 50.
- Location in the prostate: They can affect overlapping areas, especially the transition zone (BPH) and peripheral zone (cancer), which can sometimes make evaluation tricky.
- Shared symptoms: Some urinary symptoms, such as frequent urination, nocturia, weak stream, or difficulty starting urination, may appear in both conditions.
- Hormonal influence: Both conditions are influenced by testosterone and its active form, dihydrotestosterone (DHT).
Differences:
- Cellular nature:
- BPH: Non-cancerous overgrowth of normal prostate cells (benign).
- Prostate cancer: Malignant growth with potential to invade tissues and metastasise.
- Origin in the prostate:
- BPH: Mostly in the transition zone around the urethra.
- Cancer: Usually starts in the peripheral zone, away from the urethra.
- Symptoms progression:
- BPH: Primarily urinary obstruction symptoms; rarely causes blood in urine or systemic effects.
- Cancer: Early stages may be asymptomatic; later stages can show blood in urine or semen, unexplained weight loss, or bone pain.
- Risk and progression:
- BPH does not increase the risk of prostate cancer, though both conditions can coexist.
- Cancer has distinct risk factors like family history, race, and genetics.
- Diagnosis:
- BPH: Enlarged, smooth prostate on DRE; imaging shows enlargement; PSA may be mildly elevated.
- Cancer: Nodular or hard areas on DRE; biopsy confirms malignancy; PSA may be elevated, sometimes significantly.
Enlarged Prostate vs Prostate Cancer
| BPH |
Prostate cancer |
| Non-cancerous cells. |
Cancer cells are present. |
| Centre of the prostate is affected. |
Sides of the prostate are more affected. |
| PSA levels increased |
PSA levels increased. |
| Normal enlargement die to aging |
Abnormal enlargement/tumor |
| Does not spread |
Does spread |
| Not life-threatening |
Can be life-threatening |
Why BPH Doesn’t Cause Cancer
BPH is a benign enlargement of the prostate, caused by increased numbers of normal cells, primarily in the transition zone around the urethra.
- Cellular differences:
- BPH: Cells grow in a controlled manner, remain non-invasive, and do not spread.
- Prostate cancer: Malignant cells grow uncontrollably due to DNA mutations, can invade surrounding tissues, and may metastasise.
- Location difference: Most prostate cancers begin in the peripheral zone, whereas BPH occurs in the transition zone, although ~20% of cancers can arise in the transition zone.
Key point: Although both conditions share risk factors such as age and hormonal influences, they have different pathophysiological mechanisms and do not transform into one another. Studies indicate that BPH does not increase the risk of prostate cancer, and vice versa.
BPH vs prostate cancer: Symptoms
Symptoms of BPH and prostate cancer can overlap which may create confusion. Here is a brief comparison to understand.
| Symptoms |
BPH |
Prostate Cancer |
| Frequent urination |
✔ |
✔ (less common in early stage) |
| Nocturia (night time urination) |
✔ |
✔ (less common early in early stage) |
| Weak urine stream |
✔ |
Occasionally |
| Difficulty starting urination |
✔ |
Occasionally |
| Dribbling / incomplete emptying |
✔ |
Rare |
| Blood in urine or semen |
Rare |
✔ |
| Unexplained weight loss |
❌ |
✔ |
| Bone pain |
❌ |
✔ (advanced disease) |
Takeaway: BPH mostly causes urinary symptoms whereas early prostate cancer may be silent and later present with symptoms like blood in urine, weight loss or bone pain.
Also Read: Common causes of frequent urination in men
BPH vs prostate cancer: Causes
- The actual reason behind BPH is still unknown. With age, a man undergoes a shift in hormones, which can cause prostate enlargement.
- Prostate cancer, on the other hand, is an abnormal (malignant) growth of cells in the prostate gland. It is primarily caused by changes in the DNA that prompt the abnormal multiplication of cancer cells.
BPH vs Prostate Cancer: Risk Factors
Although both BPH and prostate cancer affect the same organ, their risk factors differ.
Risk Factors for BPH (Enlarged Prostate)
- Age: The risk increases after 40, with most men over 60 experiencing some degree of enlargement.
- Hormonal changes: Imbalances in hormones like testosterone and dihydrotestosterone (DHT) promote prostate cell growth, leading to an enlarged prostate.
- Family history: Men with a family history of father, brother or close relatives having had BPH are more susceptible to the risk.
- Lifestyle factors: Obesity, lack of physical activity, and metabolic syndrome can significantly contribute to BPH.
- Other medical conditions: Conditions like diabetes and heart disease have been linked to increased BPH risk.
Risk Factors for Prostate Cancer
- Age: Men over 50 are at high risk. Risk rises sharply after 65.
- Family history: If there is a genetic history, which means if an individual’s father, brother, or any close relative had prostate cancer, it significantly increases the risk.
- Genetic mutations: BRCA1, BRCA2, and other hereditary mutations increase susceptibility to prostate cancer.
- Diet and lifestyle: High-fat diets, low fruit and vegetable intake, and obesity may contribute to risk.
- Geography: Higher incidence in North America and Northern Europe; lower in Asia, possibly due to diet or genetics.
Also Read: Top 10 expert- approved tips for prostate cancer prevention
Diagnostic Procedures: How to Differentiate BPH from Prostate Cancer
Only symptom evaluation is not sufficient to differentiate between BPH and prostate cancer. Your doctor will use a combination of tests for an accurate diagnosis.
| Test Name |
Findings in BPH |
Findings in Prostate Cancer |
| Digital Rectal Exam (DRE) |
Smooth, symmetrically enlarged prostate |
Hard, nodular or irregular areas |
| PSA Testing |
Mild elevation possible |
May be elevated, but not always reliable alone |
| Imaging (Ultrasound / MRI) |
Shows overall prostate enlargement |
Detects suspicious lesions or abnormal areas |
| Prostate Biopsy |
Benign tissue growth |
Malignant (cancerous) cells confirm the diagnosis |
The Role of PSA
Prostate-Specific Antigen (PSA) is a protein produced by prostate cells and measured in blood:
- BPH: Enlarged glands can raise PSA levels.
- Prostatitis: Infection or inflammation also elevates PSA.
- Prostate cancer: PSA may be high, but not always.
Note: PSA is not a cancer-specific marker. Doctors assess PSA trends over time rather than a single result to decide if further testing is needed.
Why Regular Screening is Advised?
Even men with BPH should undergo regular prostate screening, because early prostate cancer may be silent.
- Guidelines:
- Average risk: Begin at 50.
- High-risk (family history, African, American): Begin at 45
- Very high-risk: Consider starting at 40.
- Screening includes: PSA testing, DRE, and follow-up investigations if indicated.
Benefit: Early detection increases the chances of successful treatment and reduces complications.
BPH vs Prostate Cancer: How Treatment Differs
The treatment for both these conditions is unique. Prostate cancer is treated with a multidisciplinary approach and is usually more extensive. The objective of cancer treatment is to destroy the cancer cells and stop them from growing further.
- Prostate cancer treatment may involve surgical removal of cancer cells, radiation therapy, chemotherapy, hormone therapy and more.
- Prostate enlargement is treated simply using surgical or non-surgical means to shrink the prostate back to its size and relieve symptoms. Prostate enlargement treatment includes aspects of active surveillance, medicinal use to bring the prostate back to its shape and alleviate symptoms, and surgical intervention to remove excess prostate tissue, among others.
Read: Everything you need to know about prostate enlargement: Benign prostatic hyperplasia
Closing Note
We have understood that there is no direct link between an enlarged prostate and prostate cancer. They do have some similar symptoms, but prostate enlargement does not directly lead to cancer. There are many other risk factors associated with cancer.
You can learn more about the health of your prostate at the CK Birla Hospital. Book an appointment with Dr Shalabh Agrawal, best urologist in Gurgaon today.
Also, read: The Growing Problem Of An Enlarged Prostate Gland
