Benign Prostatic Hyperplasia
A man who has an enlarged prostate, or BPH, may worry that it could become prostate cancer. Most men who get prostate cancer also have some degree of BPH, but it doesn't mean that BPH led to cancer. The two conditions have a lot in common. They both involve abnormal cell growth in the prostate; they are both very common, especially in older men; and they both are hormone dependent, that is, they depend on testosterone or its byproduct, DHT, to develop.
And, to further the uncertainty, prostate cancer is frequently diagnosed when urinary symptoms associated with BPH are being evaluated. The symptoms of the two are similar if the cancer is developing near the urethra or the bladder. Therefore, when symptoms occur, cancer needs to be ruled out. Before the introduction of prostate-specific antigen (PSA) testing in the late 1980s, about 1 in 5 surgeries to relieve BPH symptoms resulted in a finding of unsuspected prostate cancer. Today, most of these cancers are detected by PSA testing and digital rectal exams before surgery for BPH. But men with BPH still wonder if their urinary problems are a predecessor to prostate cancer.
The cause-and-effect relationship between the two is not very well established, largely because the natural course of prostate cancer remains pretty much a puzzle. But BPH has been associated with a greater risk of prostate cancer in some studies, but it has not in others. There is no clear increase in risk as a result of having a "normal" enlargement of the prostate. Normal is used because if men live long enough an enlarged prostate is almost inevitable. It seems part of the normal aging process. But does an early onset of BPH affect the risk of prostate cancer? Prospective studies that have followed men who have had prostate surgery to relieve symptoms of BPH show no increase in risk of cancer compared to men without BPH. It appears that it is more a case that having early BPH increases the chance of prostate cancer being detected, but not that it increases the chance of it developing, or progressing. The same urinary symptoms that characterize BPH are also warning signs of possible prostate cancer, so they prompt screening. And it is well established that when men are screened more, more prostate cancer is found.
What Is BPH?
BPH, or benign prostatic hyperplasia, is the abnormal growth of benign prostate cells. In BPH, the prostate grows larger and puts pressure on the urethra and bladder, blocking the normal flow of urine. This causes the flow of urine to weaken, the need to get up in the night to urinate more often, and eventually even the inability to go. More than one-half the men in the U.S. between the ages of 60 and 70 and as many as 90% between the ages of 70 and 90 have some urinary symptoms resulting from an enlarged prostate. Although it is seldom a threat to life, BPH may require treatment to relieve symptoms if they become overly bothersome.
