Prostate Cancer and Benign Prostatic Hyperplasia (BPH). The symptoms, diagnosis, treatments and prognosis.

March is Prostate Cancer Awareness month, so there’s no better time to highlight the condition and make sure that, as healthcare professionals, you’re aware of the risks, symptoms and available treatment of this condition. This will help you effectively care for people who have this condition or benign prostatic hyperplasia (an enlarged prostate).

What is prostate cancer?

The prostate is a small gland in the male reproductive system. It produces a fluid that, combined with sperm, makes semen. Prostate cancer occurs when the gland’s cells grow abnormally, forming a lump or tumour. We don’t always know why people get prostate cancer, but there are factors that increase risk, such as age, race and a family history of the condition.

Globally, prostate cancer is the second most common cancer among men. Several European countries, including France, Switzerland and the Czech Republic, are among the 20 nations with the highest incidence. Across Europe, the incidence of prostate cancer has doubled since 1995, and 75,000 men die from it every year. In the US, meanwhile, prostate cancer is the most common cancer in men. In 2022 there will be an estimated 268,490 new cases of prostate cancer across the US, with 34,500 of them being fatal.

Prostate cancer symptoms

Symptoms can be easily confused with non-cancerous conditions. These can include: difficulty urinating, needing to urinate more often, especially at night, and experiencing pain when urinating.

Someone with these symptoms may not have prostate cancer, but it’s important they have the proper checks. Early detection can increase the chance of survival. Healthcare professionals should ask what the person is experiencing, how often they have symptoms, and whether there is a family history of cancer.

How is prostate cancer diagnosed?

The most common way of diagnosing prostate cancer is by needle biopsy. Most urologists perform a transrectal biopsy using a bioptic gun with ultrasound guidance. For people at risk of transrectal complications, a transperineal ultrasound-guided method can be used.

Tests, treatment and prognosis

Various tests and scans, such as blood tests, physical exams and biopsies, check for abnormal changes. If test results show someone has prostate cancer, their treatment options and prognosis should be discussed with them. This can be partly determined by the stage and grade of their cancer, as well as their age, lifestyle and general health. However an exact outcome can’t be predicted.

Prostate cancer may be cured when localised, and it frequently responds to treatment when widespread. The rate of tumour growth varies, and some patients may have prolonged survival even after the cancer has spread to distant sites, such as bone.

Benign prostatic hyperplasia

As men age, the prostate goes through two main stages. It doubles in size during male puberty, and grows again from age 25; this growth is ongoing throughout a man’s life.

Benign prostatic hyperplasia (BPH), when the prostate gland is enlarged and not cancerous, often occurs during this second stage. It is common in older men.

As the prostate grows, it presses against and pinches the urethra and pinches it, thickening the bladder wall. Over time, this can weaken the bladder or remove its ability to fully empty itself. This, combined with the narrowing of the urethra, causes many of the problems associated with benign prostatic hyperplasia. If left untreated, BPH can lead to urinary tract infections, bladder or kidney stones, urinary retention and kidney damage.

There are several effective treatments for prostate gland enlargement, including medications and surgery. Patients’ symptoms, age, prostate size and general health need to be considered when developing a treatment plan.

Diagnosis and treatment

Physical checks should be completed to diagnose BPH, including a digital rectal exam and urine and blood tests. It’s also worth doing a prostate-specific antigen (PSA) blood test. The prostate produces PSA, and levels increase in BPH patients. If levels are high, additional tests may be needed to rule out causes.

Medication is the most common treatment for mild to moderate symptoms. Options include alpha blockers, which relax bladder neck muscles and prostate muscle fibres and make urination easier, or 5-alpha reductase inhibitors, which shrink the prostate by preventing hormonal changes that cause growth.

In moderate to severe cases, or in patients not responding to medication, minimally invasive or surgical therapy is worth considering.

References

American Cancer Society

European Federation of Pharmaceutical Industries and Associations

Mayo Clinic

National Institute of Diabetes and Digestive and Kidney Diseases

World Cancer Research Fund