Enlarged Prostate vs. Prostate Cancer: Differences Explained

Prostate conditions are often discussed in the same breath, which can make it difficult to tell where one ends and another begins. An enlarged prostate and prostate cancer affect the same gland, become more common with age, and are frequently mentioned during routine check-ups or screenings. Because of this overlap, it is easy to assume they are closely related or even part of the same condition. They differ in cause, risk, and clinical significance. Understanding why they are so often grouped together helps clarify what each diagnosis means.

Understanding the Prostate

The prostate is a small gland that sits just beneath the bladder, wrapping around the urethra: the tube that carries urine from the bladder out of the body. Due to this location, any enlargement or structural change to the prostate can directly impact the flow of urine.

The prostate is composed of distinct zones and this anatomical structure is clinically significant. Benign prostatic hyperplasia and prostate cancer usually develop in different parts of the gland, which helps explain why they behave differently and subsequently, cause different symptoms.

What Is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia is the non-cancerous enlargement of the prostate gland. It is the most common condition affecting the prostate in older men and is considered very common with ageing.

Exactly how this condition develops is not fully understood yet, but it is strongly linked to hormonal changes that occur with age. As the prostate cells multiply, the gland expands, often starting in the central part of the gland that immediately surrounds the urethra. This enlargement leads to the compression of the urethra, resulting in signs of urinary obstruction.

Common Symptoms of BPH

Benign prostatic hyperplasia commonly causes what are known as lower urinary tract symptoms. These symptoms occur because the enlarged prostate places pressure on the urethra, leading to both obstructive and irritative urinary symptoms.

Common symptoms include:

• Weaker or slower urine flow than usual during urination.
• Difficulty in starting to urinate, even when there is a clear urge to do so.
• Waking up multiple times during the night to pass urine.
• Sudden and intense urges to urinate.
• The sensation that the bladder has not fully emptied even after urinating.

What Is Prostate Cancer?

Prostate cancer involves the abnormal, uncontrolled growth of malignant cells within the prostate gland. Unlike BPH, which is always benign, prostate cancer has the potential to spread (metastasise) to other parts of the body.

Prostate cancer typically begins in the peripheral zone (the outer part) of the gland, away from the urethra. Growth patterns vary significantly: some cancers are slow-growing and may never cause problems, while others are highly aggressive.

Common Symptoms of Prostate Cancer

In its early stages, prostate cancer often exhibits no noticeable symptoms. When symptoms do develop, they can be subtle and may overlap with those seen in benign prostatic hyperplasia or other urinary conditions, which is why medical evaluation is important.

Possible symptoms include:

• Difficulty or pain during urination
• Blood in the urine or semen, which should always be investigated.
• Persistent pain or stiffness in the lower back, pelvis, or hips, which may also be a sign of more advanced disease.

What Are The Differences Between BPH and Prostate Cancer?

Although both conditions involve the prostate gland, they differ in how they are diagnosed and managed.

Nature of Growth

Benign prostatic hyperplasia involves non-cancerous enlargement of prostate tissue and does not spread beyond the gland. Prostate cancer, in contrast, is caused by malignant cell growth and has the potential to spread to other parts of the body.

Typical Location

BPH usually develops in the central part of the prostate that surrounds the urethra, which explains why urinary blockage often appears early. Prostate cancer more commonly begins in the peripheral or outer zone of the gland.

Symptom Profile

BPH tends to cause urinary symptoms early in its course due to urethral compression. Prostate cancer often causes no symptoms in its early stages and when symptoms do occur, they are frequently vague and not specific to cancer.

How Are BPH and Prostate Cancer Managed?

Management strategies differ between benign prostatic hyperplasia and prostate cancer because the conditions behave differently and carry different risks. Treatment is therefore tailored to the underlying diagnosis and its impact on daily life.

Management of BPH

Treatment for BPH focuses on relieving urinary symptoms and improving bladder emptying. The approach often progresses step by step, starting with simpler measures and only moving to more invasive options if symptoms persist.

Management options may include:

• Lifestyle adjustments, such as changing fluid intake or reducing evening drinks
• Medications, including alpha-blockers or 5-alpha reductase inhibitors, to improve urine flow or reduce prostate size
• Minimally invasive procedures, such as UroLift or Rezum, which aim to relieve obstruction with shorter recovery times
• Surgical treatments, including transurethral resection of the prostate (TURP) or Holmium Laser Enucleation of the Prostate (HoLEP), for more severe or persistent symptoms

If urinary symptoms suggest an enlarged prostate, further information on available treatment options may be helpful when discussing next steps with our specialist.

Management of Prostate Cancer

Prostate cancer management is more individualised and depends on factors such as tumour aggressiveness, disease stage, and overall health. The goal may range from careful monitoring to active treatment.

Common approaches include:

• Active surveillance for low-risk cancers that may not require immediate intervention
• Radiation therapy, such as external beam radiation or brachytherapy
• Hormone therapy to slow cancer growth
• Surgical removal of the prostate, known as radical prostatectomy

Can BPH Turn Into Prostate Cancer?

It is a common misconception that BPH can progress into prostate cancer. This is medically incorrect. BPH and prostate cancer are two entirely separate conditions that originate from different types of cell changes within separate areas of the prostate. An individual may have both BPH and prostate cancer simultaneously, but one does not cause the other.

The evaluation process is designed to determine the cause of a patient's symptoms and to rule out malignancy. This process often involves several steps:

• Medical History and Physical Examination: Your doctor will review urinary symptoms, general health, and risk factors. A digital rectal examination may be performed to assess the size, shape, and texture of the prostate.
• PSA Testing: A blood test measures the levels of prostate-specific antigen (PSA). While PSA can be elevated in prostate cancer, levels may also rise due to benign prostatic hyperplasia, infection, or recent physical activity, so results must be interpreted carefully.
• Imaging Studies: Ultrasound is commonly used to evaluate prostate size and bladder function. In some cases, multiparametric MRI may be recommended to identify areas that appear suspicious and guide further testing.
• Prostate Biopsy: When imaging or PSA results raise concern, a biopsy may be performed to obtain tissue samples. This is the definitive step for confirming whether cancer cells are present.

When Should Men See a Urologist?

Men should consider consulting a urologist if they experience persistent urinary symptoms, such as nocturia, difficulty voiding, or blood in the urine or semen. Early consultation is vital for accurate diagnosis and a specialist can provide a comprehensive assessment, guide you through appropriate diagnostic tests and formulate a personalised treatment plan tailored to your specific needs.

Seeking Specialist Care for Prostate Conditions

Prostate issues are common as men age. While benign prostatic hyperplasia and prostate cancer require different treatment approaches, there is a common silver lining. With guidance from a specialist team, these conditions can often be managed in ways that support an optimal quality of life.

At Urology Practice, our patient-focused approach, combined with expertise in advanced techniques, ensures tailored, evidence-based urological care for all patients. Heading the practice is Dr Jonathan Teo, a fellowship-trained consultant urologist with experience in managing a wide range of prostate conditions, including BPH and prostate cancer. If you are seeking a urologist in Singapore, get in touch for a personalised assessment and an in-depth discussion of the appropriate treatment options.