Advance with MUSC Health

The Difference Between Prostate Cancer & BPH

Advance With MUSC Health
August 19, 2021
Dr. Grubb using prostate monitor
Dr. Robert Grubb 
Dr. Robert Grubb

Benign prostatic hyperplasia (BPH) and prostate cancer can have similar symptoms. An enlarged prostate and an elevated PSA are present in both conditions. But an important distinction between the two exists: Although BPH causes prostate cells to multiply, those cells aren’t cancerous and don’t spread to other parts of the body, and BPH doesn’t put a man at risk for prostate cancer. We talked with Dr. Robert Grubb, MUSC Health board-certified urologist and associate professor of urology, to answer our questions about BPH and prostate cancer. Read below to find out symptoms, treatments and who is at risk. NOTE: Statistics referenced in this Q&A are from the American Cancer Society.

Q. How prevalent are BPH and prostate cancer?

A. BPH is one of the most commonly diagnosed conditions in men as they age. Prostate cancer is second only to skin cancer as the most common cancer in American men. According to the American Cancer Society, about 248,530 new cases of prostate cancer will be diagnosed in the United States in 2021, and about 34,130 men will die from the disease.

Q. What are the symptoms of prostate cancer?

A. Most early cases of prostate cancer are asymptomatic. Most cancers are diagnosed on the basis of an elevated PSA blood test or by an abnormal rectal exam performed by your doctor. Prostate cancers rarely cause urinary or sexual symptoms until later stages. It is important to emphasize that having an elevated PSA does not mean someone has cancer; likewise, some men will be diagnosed with prostate cancer despite a PSA in the normal range.

Q. What are the symptoms of BPH?

A. BPH can cause an enlarged prostate and an elevated PSA. Symptoms can include difficulty urinating, a slow urine stream, frequent urination at night and a feeling that the bladder is not empty. Prostate cancer often doesn’t show symptoms in its earliest stages.

Q. Who is at risk BPH and/or prostate cancer?

A. Because the prostate grows as a man ages, the chances of getting BPH and prostate cancer increase with age. Diagnoses increase after age 40 and rise dramatically after age 50. Most men diagnosed with prostate cancer are over 65. Other risk factors for BPH and prostate cancer include a family history of BPH or prostate cancer, weight (obesity) and race. The incidence of prostate cancer is higher in African American men and men of northern European descent.

Q. How is BPH diagnosed?

A. BPH can be diagnosed with a digital rectal exam. Other diagnostic tests include testing urine flow rate and PSA testing. An elevated PSA can be due to an enlarged prostate.

Q. How is prostate cancer diagnosed?

A. The initial screening tests are the same as the tests used for evaluation of BPH. We continue to rely on the PSA test as the effective screening tool for prostate cancer and advance to other methods as needed. These include an MRI, ultrasound and a biopsy of the prostate tissue. We also use a 4K blood test to identify men at high risk for having more aggressive prostate cancer. The 4K test can further determine the need for a prostate biopsy. In addition to PSA, it measures the blood levels of other kallikrein proteins (of which PSA is the most common). We consider those results with a patient’s age, digital rectal exam findings, any prior biopsy results and the patient’s family history to determine a patient’s risk for developing aggressive prostate cancer. The advantage of this method allows us to avoid over-diagnosing patients with low-grade prostate cancer and to better identify men with higher grade cancers while avoiding an unnecessary biopsies.

Q. What are the treatments for BPH and prostate cancer?

A. BPH treatments range from medications that shrink the prostate or relax the bladder to surgical procedures that improve urine flow by reducing the size of the prostate. Prostate cancer can be treated with hormone therapy, surgery (robotic assisted radical prostatectomy), cryosurgery and radiation.

Q. What is active surveillance?

A. Active surveillance, which we also call watchful waiting, means we monitor a patient’s condition but don’t prescribe treatment at time of diagnosis. We recommend active surveillance only for prostate cancer patients whose cancer is at low risk of progressing. It’s important to point out that throughout our treatment and care, we practice shared decision-making and involve our patients at every step.

Q. When should I get screened for prostate cancer?

A. The American Urological Association recommends beginning discussion of annual screening at age 55 for men at average risk of prostate cancer. Men at higher risk (African American men or those with a strong family history of prostate, breast, ovarian and pancreatic cancers) may wish to consider screening at an earlier age. I often begin the conversation about screening with my patients within the context of men’s health and certain conditions such as sexual dysfunction or urinary problems. The discussion offers the opportunity to talk about whether screenings are appropriate. Certainly, we want to minimize over-diagnosing or overtreating patients with slower growing cancers that are less likely to become symptomatic or spread to other parts of the body.

Q. What can I do to prevent or lower my risk for BPH and prostate cancer?

A. Some studies show that prostate cancer is genetic. Engaging in heart-healthy behaviors, however, such as exercising regularly, maintaining a healthy weight, and following a low-fat diet with cruciferous vegetables (cauliflower, broccoli and Brussels sprouts) and lycopene, (beets, tomatoes, watermelon) are recommended for individuals who have a higher risk of developing any type of cancer.

Q. What kind of treatments does MUSC Health offer for prostate cancer?

A: MUSC Health offers an array of advanced therapies, including clinical trials, for cancer and urological conditions. MUSC Health is nationally ranked in U.S. News & World Report for urology treatment and care, and is home to the NCI-designated MUSC Hollings Cancer Center.

To learn more about urology services or make an appointment with Dr. Robert Grubb, call 843-792-7888.