How can benign prostatic hyperplasia (BPH) be distinguished from prostate cancer?
This is a very good topic, because distinguishing between the two is one of the key factors here. What does that involve?
There is a big difference between a benign enlargement — often also called hyperplasia, or prostate adenoma — and cancer. Here, too, it can be detected with specific examination methods. You could also call this early diagnosis.
Because if there is cancer, the sooner it is diagnosed through examination, the more appropriate the treatment that can be applied to move the patient away from this cancer — even to free them of it. With a benign adenoma, that is, BPH, what complaints occur? Both can cause the same complaints.
Both in cancer and in BPH. There may be obstructive voiding complaints. So BPH and cancer can cause the same complaints.
These are called obstructive voiding complaints: a weak urine stream, getting up at night to urinate, hesitancy, and a sensation of residual urine — a feeling that the bladder hasn’t emptied completely. These complaints can occur in both conditions.
However, prostate cancer is a disease that cannot be detected from these complaints alone. Additional examination methods must be used here, namely PSA (prostate-specific antigen).
That is a blood test. Its result can always give us grounds for that suspicion. It doesn’t necessarily mean that if PSA is high, there is cancer.
Because the cause may also be inflammation. That’s why additional examination methods must be used. There is one that our men don’t like — it’s called the digital rectal exam.
And this digital exam is a very important examination. It reveals the consistency of the prostate. Is it hard like bone, or is it soft?
If it is hard, that tells us there is a possibility that this patient has cancer. Sometimes the prostate may be firm even though PSA is not elevated. There is an examination method that adds to this — it’s called MRI, multiparametric prostate MRI.
Its result is graded as well: PI-RADS 1, 2, 3, 4, 5. If it is above three, there may be a suspicion that prostate cancer could be present. In such cases, all of these raise suspicion.
The examination method that establishes the definitive diagnosis is a biopsy. If any of these three examinations — the digital exam, PSA or MRI — or even just one of them raises the suspicion that prostate cancer may be present, then a biopsy should be performed. And the biopsy then makes it clear whether there is cancer or not.
If this examination is done early, at an early stage, and the diagnosis is made correctly, we can be of great help to our patient, and the patient can benefit from it. In such cases — I’ll say it again — many urologists, for example, don’t even perform this digital exam. Yet it is of great importance.
It is important to differentiate between benign enlargement and prostate cancer. As I said, if the digital exam and the MRI raise no suspicion and the PSA is not elevated, then a diagnosis of BPH is made and only BPH treatment is carried out. In other cases, it may even end with removal of the prostate. In such cases patients must receive the appropriate examination and treatment.
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