Although benign prostatic hyperplasia (BPH) or enlarged prostate is a common condition among older men, it doesn’t necessarily mean cancer on the horizon.

Severity of BPH symptoms varies but typically worsen over time. Such symptoms may include an increased frequency of urination at night; urgent need to urinate; difficulty in starting urination; weak urine stream or a stream that stops and starts; dribbling following urination and inability to completely empty the bladder.

Symptoms less commonly include the inability to urinate; urinary tract infection; and blood in the urine. Factors likely to increase the likelihood of BPH include aging, particularly over the age of 60, lifestyle factors such as obesity and lack of exercise, a family history of BPH, and the presence of diabetes and heart disease.

Although symptoms of BPH may be alarming or annoying, their presence doesn’t mean you’re on the path to a cancer diagnosis. In fact, a recent study suggests that BPH may actually offer protection from developing cancer. “Men are often anxious about prostate cancer, as it is the second most common cancer in men, with some worrying BPH increases their risk of prostate cancer,” said the study’s lead researcher, Kiran R. Nandulur, MD, a diagnostic radiologist at Beaumont Hospital in Royal Oak, MI.

“Some previous studies have demonstrated BPH may increase the risk of cancer, given common driving forces such as genetics, hormones and inflammation. Our study should alleviate their concern, as BPH may decrease their odds of prostate cancer,” Nandulur said. Surprisingly, as the prostate continues to enlarge, the odds of prostate cancer go down, Nandulur explained.

“Moreover, BPH decreases the odds of not just a single focus of cancer, but also more than one site. Based on these findings, BPH may be producing mechanical pressure throughout the gland, which inhibits cancer growth and decreases the odds of prostate cancer,” Nandalur said.

From the data related to 405 men with BPH that searched MRIs of prostate tissue for evidence of prostate cancer, researchers found that as the size of the prostate increased, the risk of prostate cancer decreased. For every single cubic centimeter increase in the volume of the prostate, the risk for prostate cancer dropped by approximately 3%. “The size of the central gland from BPH may help to stratify risk for patients with prostate cancer,” Nandalur said

“Currently, prostate cancer patients are categorized into low, intermediate and high risk, with central gland contributions not taken into account. In the future, the degree of BPH as measured on prostate MRI may also be contributory to help determine prognosis and the course of therapy,” he said. Some commonly used BPH drugs, including Proscar, decrease the size of the prostate and have a U.S. Food and Drug Administration drug safety warning because they have been found to increase the risk of high-grade prostate cancer, Nandalur said.

“Our study finds a potential explanation for the findings, as decreasing the prostate size with these drugs may lead to decreased pressure throughout the gland and possibly allow cancer to grow. These are very useful drugs to treat BPH, but care should be taken,” Nandalur said.

The study findings could result because BPH creates difficulty in finding cancer with a biopsy, according to Anthony D’Amico, MD, PhD, a professor of radiation oncology at Harvard Medical School in Boston. “BPH could make it harder to find cancer because your needle is now going into a much smaller area,” he said. However, the findings may have a biological explanation, he noted.

“If you have a lot of BPH, that’s competing with prostate cancer for growth factor, maybe the prostate cancer gets a growth disadvantage,” D’Amico said. “That’s a biological premise, but it’s not been proven.” He advises men with BPH to undergo MRI and biopsy to ensure there’s no cancer present.

There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. To choose the best treatment for your condition, you and your provider should discuss your symptoms, the size of your prostate, other health conditions you might have and then consider your preferences.

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