Determining whether prostate problems are being caused by prostate cancer or BPH is a dilemma many older men face.
While prostate cancer is usually silent — it doesn’t cause symptoms — it can cause urinary symptoms similar to BPH, including difficulty starting a urine stream, a feeling that the bladder has not fully emptied, a sudden urge to pass urine, increased frequency of urination (especially at night), and a weak urine stream.
Fortunately, BPH does not appear to increase the risk of developing prostate cancer. The best evidence for this comes from an analysis of a very large study sponsored by the National Cancer Institute (NCI) — the Prostate Cancer Prevention Trial (PCPT).
As the name suggests, this was a cancer-prevention study, not a BPH study. However, during the course of the prevention trial, prostate biopsies were performed in many men who would not otherwise have had a prostate biopsy, providing a unique opportunity to assess rates of prostate cancer in men with and without urinary symptoms. This analysis revealed that men with urinary symptoms were no more likely to have prostate cancer than those without symptoms.
Types of treatment
If prostate symptoms from BPH are interfering with your daily activities, you may benefit from medical treatment.
Two different types of drugs have been FDA-approved for the treatment of symptomatic BPH: alpha-blockers, which facilitate the flow of urine by relaxing smooth muscle within the prostate; and 5-alpha-reductase inhibitors (5-ARIs), such as finasteride and dutasteride, which block the conversion of testosterone to the more potent dihydrotestosterone within the prostate, thus decreasing the size of the gland.
These drugs, which can be used either alone or in combination, are highly effective for symptomatic BPH and have gone a long way toward eliminating the need for surgical intervention (a procedure known as a “TURP,” or transurethral resection of the prostate) to treat BPH.
Evaluating the data
The main finding of the PCPT was that finasteride substantially decreased the overall risk of prostate cancer. However, due to a small but statistically significant increase in higher grade (potentially more aggressive) prostate cancers among the men who received finasteride, this drug was not approved for prostate cancer prevention.
Follow-up analyses of the PCPT suggested the observed increase in higher grade prostate cancers was due, at least in part, to the fact that finasteride increases the sensitivity of PSA for the detection of higher-grade cancers and decreases the size of the gland, making it easier for a biopsy to detect the presence of high-grade cancer.
Most recently, an 18-year follow-up study of the PCPT found no increase in prostate cancer deaths among men who had received finasteride in the PCPT, providing additional reassurance that finasteride most likely does not increase the risk of lethal prostate cancer.
Urinary complaints become increasingly common as men age. Fortunately, they are most often due to BPH, a benign condition, rather than to prostate cancer. However, if urinary symptoms are interfering with your daily life, medical intervention may be considered.
The information provided here is for informational purposes only and does not constitute, nor is it intended to provide, medical advice to readers of the publication. Individuals should consult with their own medical team for medical advice that best supports their individual situation. For additional information, visit NCI’s website (www.cancer.gov), which offers extensive information about prostate cancer and other conditions, including: https://www.cancer.gov/types/prostate/understanding-prostate-changes.
Howard L. Parnes, M.D., National Cancer Institute, [email protected]