Benign prostatic hyperplasia (BPH) is one of the most common urological conditions that affects most older men worldwide. BPH and prostate cancer can have similar symptoms resulting in confusion and concern. However, they are not related and have quite distinctive features that set them apart. In this article, we will take a closer look at the intricacies of BPH and prostate cancer, shedding light on how they differ from each other, how they develop, how they can be treated and more.

BPH and Prostate Cancer: Understanding What They Are and How They Develop

BPH is characterised by an enlarged prostate; the prostate gland is a walnut-sized organ that sits below the bladder. This accessory gland is responsible for producing fluid that nourishes the seminal fluid (semen). Seminal fluid contains a variety of proteins that are essential to keep sperms viable and maintain their physiological function. The risk of BPH increases as men age, especially those over 50, with several clinical studies suggesting that nearly 3 in 4 men will be affected by it over their lifetime.

Causes: Although the cause of BPH is relatively unknown, many experts believe that it is linked to hormonal changes that occur in males as they get older. But BPH does not become cancerous. 

Prostate cancer is now the most common cancer among men in Singapore, affecting over 12% of all cancers. It develops when abnormal cells in the prostate gland proliferate, forming a malignant tumour. As with benign prostatic hyperplasia, prostate cancer may feature an enlarged gland, but the growth is cancerous. This means it can spread to adjacent tissues and organs (metastasis) and might even be life-threatening.

Causes: While the exact cause is not known, there are certain factors that can increase your risk of developing the condition, including age, a family history of prostate cancer, and obesity. 

What Are the Symptoms of BPH and Prostate Cancer: How Similar Are They? 

It can be difficult to distinguish between the two as they share a number of similar symptoms and they include the following:

• Urgent need to urinate (especially at night)
• Weak or interrupted urine flow
• Difficulty passing urine
• Painful urination or ejaculation
• Sudden urge to urinate

BPH symptoms often occur gradually but tend to result in urinary symptoms earlier than prostate cancer. Here are a few other symptoms that can occur with benign prostatic hyperplasia:

• Slow urinary flow
• The need to strain when urinating
• A sensation of incomplete voiding
• Dribbling after urination

Prostate cancer usually does not present with any signs or symptoms in the early stages, but the following may occur in the advanced stages:

• Blood in urine or semen
• Burning when passing urine
• Pain when ejaculating
• Pain in the back or pelvis
• Unexplained weight loss
• Erectile dysfunction
• Bone pain (commonly occurs in advanced prostate cancer)

Risk Factors of Benign Prostatic Hyperplasia and Prostate Cancer: Who is More Susceptible for Each?

While any male can become affected by BPH and prostate cancer, there are some common factors that can increase the risk for both:

Family history: Patients who have a family history of BPH or prostate cancer are more likely to suffer from it.

Weight: While obesity has been shown to have a link to the development of BPH, there is no clear evidence to state that the BMI (body mass index) has an impact on prostate cancer. However, certain experts do believe that there might be a connection between an increased BMI and the incidence of cancer, including that of the prostate.

When it comes to BPH alone, there are several risk factors that can increase an individual’s risk of developing benign prostatic hyperplasia, and they include the following:

• Age (especially those over 50)
• A sedentary lifestyle
• An unhealthy diet (high in fats)
• Certain medications like anti-hypertensive drugs (blood pressure-lowering drugs)
• Type 2 Diabetes

Individuals over 50 may also be at risk of developing prostate cancer, but age is not the only risk factor – there are many other factors, including:

• Prostatitis (inflammation of the prostate)
• Smoking
• Chemical exposure

According to certain research studies, sexually transmitted infections like gonorrhoea and chlamydia may also increase the odds of developing prostate cancer. In addition, several studies have also shown that excessive animal fat consumption and high levels of calcium may contribute to this risk. However, due to the presence of conflicting results, no definitive conclusion has been reached.

Treatment of BPH and Prostate Cancer: How Are They Assessed and Managed? 

Benign Prostatic Hyperplasia – Diagnosis

As both benign prostatic hyperplasia and prostate cancer share similar symptoms, it is necessary to be evaluated by a medical professional such as a urologist. The diagnosis of BPH is usually confirmed by carrying out a digital rectal examination (DRE) and other investigations such as blood tests (PSA screening test), and urine tests. Certain imaging modalities such as Ultrasound scans, MRI scans, and cystoscopy may also be necessary to come to a definitive diagnosis.

Benign Prostatic Hyperplasia – Treatment

Treatment will depend on the severity of the symptoms and may involve a range of treatments, including medication (e.g., alpha-blockers) and surgical treatments (e.g., TURP and robotic-assisted simple prostatectomy). Your doctor may also recommend some lifestyle changes such as consuming high-fibre diets, drinking fewer fizzy drinks and alcohol and trying double voiding.

Prostate Cancer – Diagnosis

As with BPH, a series of tests such as digital rectal examination, PSA test, and imaging tests like MRI scans will be required for the diagnosis of this cancer. If any abnormal areas are observed from these imaging scans, a tissue sample from the abnormal tissues will be taken and sent to a pathologist for further analysis (biopsy).

Prostate Cancer – Treatment

Treatment will vary depending on the person’s health condition and situation, the stage of the cancer and the risk classification (low risk, intermediate risk, high risk and very high risk). Generally, a multidisciplinary team will work together to come up with a suitable treatment plan, and a combination of management options may be used to treat the cancer.

• Active surveillance: Active surveillance may be an option for low risk prostate cancers, and treatments can cause complications. In light of this, doctors may decide to monitor the progress of the cancer closely for any signs of worsening. If the cancer shows signs of progression, treatment will be given promptly.
• Surgery: Your surgeon may carry out a radical prostatectomy (removal of the prostate and the seminal vesicles). This procedure can be done through open, laparoscopic, or robot-assisted surgery.
• Radiation therapy: This treatment modality involves the use of high-energy rays to kill cancer cells and is especially recommended for older patients with multiple medical issues.

When it comes to metastatic cancer – cancer that has spread to other parts of the body, doctors may turn to treatment options such as symptomatic therapy, chemotherapy and androgen deprivation therapy (ADT).

If you are concerned about the possibility of having benign prostatic hyperplasia or prostate cancer and are in need of an experienced urologist in Singapore, look no further than Assure Urology & Robotic Centre. Our team helmed by our dedicated Senior Consultant Urologist, Dr Terence Lim will provide you with the right treatment and will be with you throughout your treatment and recovery journey. Get in touch with us today!