Does BPH (Benign Prostate Hyperplasia) Lead to Prostate Cancer?

Benign prostate hyperplasia (BPH) is a common condition among men in their 60s and 80s that is caused by an enlargement of the prostate. Conflicting research poses speculation as to whether BPH actually leads to prostate cancer.

Here, Mark Pomerantz, MD, a medical oncologist at Dana-Farber Cancer Institute who specializes in treating prostate cancer, clarifies this connection and explains BPH as distinct from prostate cancer diagnosis.

Does BPH lead to prostate cancer?  

According to Dr. Pomerantz, the short answer is no. BPH is much more common than prostate cancer. Even though it is not unusual for a person to have both BPH and prostate cancer, the two conditions are unrelated. “If most men get BPH and a high percentage of men get prostate cancer, they’ll be a lot of men who have both,” says Pomerantz, “People have wondered over the years whether they’re related, but there is no solid evidence that there is a relationship between the two.”

Mark Pomerantz, MD.
Mark Pomerantz, MD.

What do BPH and prostate cancer have in common?

Both BPH and prostate cancer enlarge the prostate, cause urinary symptoms, make PSA (prostate- specific antigen marker, which is found in the blood and used to screen for prostate cancer), and have a hereditary component. Research shows that obesity is a risk factor for both BPH and prostate cancer, and can make urinary symptoms worse in both cases.

What causes BPH in older men?

BPH occurs when the prostate—the gland that sits below the bladder and surrounds the urethra—swells and becomes larger in size. This narrows the urethra, therefore creating urinary problems.

“Some research suggests that chronic inflammation that just accumulates over a person’s lifetime promotes the growth of BPH,” says Pomerantz, “there does seem to be a hereditary component too, but it really is unclear about why it forms and why it forms more in some men than others.”

Testosterone levels also affect the development of this non-cancerous condition. “There’s no question that the hormone testosterone is associated with BPH,” says Pomerantz, “We know this because there are rare diseases in which people don’t properly make testosterone—and those people don’t get BPH.” There are no other hormones associated with BPH.

How do you distinguish BPH from prostate cancer?

While both BPH and prostate cancer make PSA, you can begin to separate cases of BPH from cases of prostate cancer by identifying where growth in the prostate occurs. In BPH, cells usually proliferate near the center of the prostate, right where the urethra runs through. This growth of tissue around the urethra can lead to “some blockage, retention of urine, and this feeling that you have to urinate all the time because you never successfully empty your bladder,” says Pomerantz. Prostate cancer is distinct from BPH as tumor cells tend to form around the perimeter of the prostate gland. Pomerantz notes, “The cells undergo a completely different transformation that has potential to spread and cause more harm.”

What are the symptoms to look out for in BPH and prostate cancer?

Symptoms of both BPH and prostate cancer include: an urgent need to urinate; urinating many times during the day and night; difficulty urinating; a weak urine stream; and feeling like your bladder is always full. Some prostate cancer symptoms are painful or burning urination, blood in urine and semen, and trouble getting an erection.

Can BPH be prevented or treated?

Currently, there are no known methods of preventing BPH, but if diagnosed with BPH, patients have treatment options. There are BPH medications that “open up the urethra by decreasing inflammation around that tube and help to shrink the prostate” says Pomerantz, yielding urination relief. There are also urologic procedures (such as transurethral resection of prostate, or TURP) and can open up blockages caused by BPH, removing this extra prostate tissue. “This can provide a lot of relief for a long time, but the BPH could eventually grow back,” says Pomerantz.

However, if a patient treated for BPH is also screening for or monitoring prostate cancer, physicians must proceed with caution because BPH medications can alter PSA levels. Pomerantz explains that a class medications called 5-alpha-reductase inhibitors decrease PSA, on average, by 2-fold.” Since PSA is a marker for prostate cancer that typically increases when this cancer is present, this PSA effect must be taken into consideration when interpreting the PSA number.