Is It BPH or Prostate Cancer?

Many men come to our office with lower urinary tract symptoms or LUTS and very concerned about the prospect of prostate cancer. While there is always a chance of prostate cancer, the likelihood of other prostate conditions is far higher. In fact, prostate cancer is most often asymptomatic except in the very worst stages of the disease. So, right off the bat, it is important to understand the “symptoms of prostate cancer” are, more likely than not, related to the common, non-cancerous condition known as Benign Prostatic Hyperplasia or BPH.

Similarities between the two:

  • Urgency to urinate
  • Trouble starting or maintaining urine flow
  • The feeling that the bladder hasn’t fully emptied
  • A weak stream including dribbling
  • The need to urinate often

These symptoms may also be caused by prostatitis, a catch-all condition when symptoms are non-specific and may require some watchful waiting to see if they improve or worsen.

Prostate cancer will often present with additional symptoms as well including

  • Pain when urinating or ejaculating
  • Blood in the urine or semen
  • Erectile dysfunction or impotence
  • Pain in the lower abdomen or back

But My PSA Is High

PSA or Prostate Specific Antigen is a useful tool in assisting with the diagnosis of prostate cancer. But there are a number of issues, including BPH, that may cause a man’s PSA to rise. As a result, Dr. Engel takes single PSA readings with a grain of salt. Indeed, in most cases, only after a series of PSA readings that continue to increase, do we consider a biopsy of the prostate.

It’s Not Cancer but I’m Still Uncomfortable

When you come in to see Dr. Engel and prostate cancer has been ruled out, you may feel a wonderful sense of relief, but ultimately the lower urinary tract symptoms are not improved. You will fill out an IPSS scorecard to understand the degree to which the symptoms are affecting your everyday life and lifestyle. For some, benign prostatic enlargement may be mildly interruptive, while for others the symptoms may be unbearable. The IPSS score is a great way for Dr. Engel to understand how much a patient is suffering.

To that end, depending on the ultimate cause of these urinary symptoms, there are many effective minimally invasive interventions offering significant relief. For BPH, one of these is known as a TUNA or Transurethral Needle Ablation. Dr. Engel likes to call this procedure a “free swing” when medication or lifestyle changes fails to improve the urinary symptoms associated with BPH. TUNAs are very effective and do not preclude further procedures. It is often unnecessary to go straight to surgery (in the form of a TURP \ Transurethral Resection of the Prostate) which comes with a number of potential side effects. Rather, the TUNA procedure kills excess prostatic tissue in an effective, in office and relatively comfortable procedure. Moreover, if the procedure does not offer its intended benefit or if the benefit wears off, usually after 5 to 7 years, patients have the full range of BPH treatments still at their disposal including re-doing a TUNA or moving on to surgery.

You do not need to live with untreated urinary symptoms getting in the way of your lifestyle. Some may be diagnosed with prostate cancer, but the vast majority will be diagnosed with benign enlargement of the prostate. At very least, after a consultation, you will have an idea of treatment options and a frank and direct opinion from Dr. Engel about what may be best for your particular circumstance.

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