BPH vs. Prostate Cancer: What’s the Difference?

Medically Reviewed by Sabrina Felson, MD on May 12, 2022
7 min read

Benign prostatic hyperplasia (BPH) and prostate cancer are two of the most common conditions that affect the prostate, a gland that’s part of the male reproductive system.

Positioned below the bladder, your prostate helps with the production of semen. In a young man, it’s generally about the size of a walnut, though it tends to get bigger as you get older. Your risk of developing a prostate problem also increases with age.

Because they affect the same gland, you may wonder if BPH leads to prostate cancer. It doesn’t. While you can develop both problems, one does not lead to the other.

Some of the symptoms and risk factors are similar, though.

The word “benign” in benign prostatic hyperplasia means it’s not cancer. “Hyperplasia” means an increased number of (noncancerous) cells. BPH is also known as an enlarged prostate.

It’s not clear what causes an enlarged prostate, but age appears to play a role. The main male hormone is testosterone, and your testosterone level naturally goes down with age.

Along with testosterone, you produce smaller amounts of a hormone called dihydrotestosterone (DHT) and the female hormone estrogen. Some researchers theorize that as your testosterone drops, it leaves you with higher proportions of estrogen and DHT. This could prompt prostate cells to spread.

The main risk factors for BPH are being male and being older. It’s rare if you’re under 40. Half of all men between ages 51 and 60 have BPH. It may affect as many as 90% of men older than 80.

Other risk factors for BPH include:

  • Family history: Having blood relatives with BPH boosts your risk
  • Overall health: Conditions such as diabetes or heart disease increase your odds
  • Obesity and lifestyle: Obesity may raise your risk, while exercise can lower it

Cancer starts when cells develop changes in their DNA, causing abnormal cells to grow out of control. Exactly what sets this off in prostate cells isn’t clear.

As with BPH, the biggest risk factors for prostate cancer are being male and aging. Those 50 and up are at highest risk. About 13 of every 100 men will get prostate cancer during their lifetimes.

Other risk factors are:

  • Race: African American people have the highest risk, followed by white, Hispanic, and Native American people
  • Family history: Having a father or brother who has had it puts you at higher risk
  • Diet: A high-fat diet boosts your odds

Some symptoms common to both BPH and prostate cancer are:

  • Frequent or urgent need to pee, especially at night
  • Difficulty peeing
  • Weak, slow, or interrupted stream when you pee
  • Pain when you pee or ejaculate

Other symptoms of BPH are:

  • Dribbling after you pee
  • Your pee has an unusual odor or color
  • You feel like you haven’t fully emptied your bladder
  • Pushing or straining to pee

Some other symptoms of prostate cancer are:

  • Burning when you pee
  • Blood in your pee or semen
  • Lasting pain in your pelvis, hips, back, or bones

If you're 40 or over, a digital rectal exam may be part of your routine physical, even if you have no symptoms. This is a way for your doctor to feel for abnormalities of your prostate. For the exam, your doctor slides a gloved, lubricated finger into your rectum. It only takes a moment or two, but it allows your doctor to check your prostate for:

  • Size, firmness, and texture
  • Lumps or growths
  • Tenderness or pain

Your doctor may also examine your scrotum and nearby lymph nodes, glands that are part of your immune system. The results of the exam, along with your symptoms and family health history, help determine the next steps. If your doctor suspects an issue, they may refer you to a urologist, a doctor who specializes in the male reproductive system and urinary problems.

A prostate-specific antigen (PSA) blood test can help detect prostate cancer. PSA is a protein made in the prostate. If you have prostate cancer, you usually have higher levels of PSA in your blood.

But high PSA doesn’t necessarily mean you have prostate cancer. Some people have a naturally higher PSA level than others. A few other reasons for elevated PSA include:

  • BPH
  • Proctitis, a type of inflammation of the prostate
  • A recent medical procedure, such as prostate surgery or biopsy

While the PSA test can offer helpful information, it’s not enough to make a diagnosis of prostate cancer. Even a bike ride or recent sexual activity can increase your PSA. Prostate cancer is diagnosed with a biopsy. That’s a procedure in which your doctor removes a tissue sample, which is then examined in a lab to look for cancer cells

If your prostate is mildly enlarged and you’re not bothered by symptoms, there’s no danger in living with BPH. Unless you develop troublesome symptoms or your annual checkup uncovers something new, you may not need treatment.

When symptoms are a problem, you can do a few things on your own to relieve them, such as:

  • Cut down on fluids as you get close to bedtime
  • Go easy on alcohol and caffeine
  • Avoid diuretics, medicines that move extra fluid out of your body, at least at night
  • Exercise your pelvic floor muscles

Treatment for BPH may include medications that can help control the growth of your prostate and reduce symptoms. Some of these are:

  • Alpha blockers: These help relax muscles and improve the flow of urine
  • Phosphodiesterase-5 inhibitors: They’re usually prescribed for erection problems, and may help relax muscles in the lower urinary tract
  • 5-alpha reductase inhibitors: They help block your body’s production of DHT hormone

If medicines don’t work, your doctor may recommend a minimally invasive procedure to destroy specific areas of prostate tissue. Some of these are:

  • Transurethral needle ablation, which uses radio waves to destroy excess tissue
  • Transurethral microwave thermotherapy, which uses microwave energy
  • High-intensity focused ultrasound (HIFU), which removes tissue with ultrasonic waves
  • Transurethral electrovaporization, which works by using heat in a focused area
  • Water-induced thermotherapy, which uses heated water to remove the extra tissue

Some surgical procedures to remove enlarged prostate tissue are:

  • Transurethral resection of the prostate (TURP), in which your doctor removes the tissue through your urethra (the opening in your penis)
  • Laser surgery
  • Open prostatectomy, where your surgeon makes an incision to do the work
  • Transurethral incision of the prostate (TUIP), which works similarly to TURP

Your doctor may suggest approaches called active surveillance or watchful waiting when your cancer:

  • Hasn’t spread beyond your prostate (it’s localized)
  • Is slow growing
  • Isn’t causing symptoms

That means your doctor won’t treat the cancer. But with active surveillance, you’ll get testing and exams every 1-3 years to keep an eye on it. Watchful waiting involves less frequent testing. It’s more focused on managing any symptoms you might have.

Treatment for prostate cancer depends on things like:

  • Your age
  • Your overall health
  • What stage your cancer is in when you’re diagnosed

Treatments can include:

Radiation therapy. This treatment uses high-energy beams to destroy cancer cells. External beam radiation targets a precise area. Brachytherapy is a type of internal radiation therapy in which your doctor places radioactive seeds inside your prostate.

Prostatectomy. This is surgery to remove your prostate. Your surgeon can do this either through an abdominal incision or laparoscopically, which uses smaller incisions and a camera to help guide the surgery.

Focal therapies. These include newer localized treatments for prostate cancer such as:

  • High-intensity focused ultrasound, like that used for BPH
  • Cryotherapy, which uses very cold temperatures to kill cancerous cells
  • Laser ablation, which works by laser energy
  • Photodynamic therapy, in which light energy destroys the cancer

Systemic therapies are designed to treat the whole body. When cancer has spread outside the prostate, your doctor may recommend:

  • Chemotherapy
  • Androgen deprivation hormone therapy, which uses drugs or surgery to reduce your body's production of a hormone that helps prostate cancer grow
  • Immunotherapy, drugs that harness your own immune system to fight cancer

Your BPH symptoms may never be bad enough to need treatment. Most people who get it don’t have serious complications, but they can include:

  • Blood in your urine
  • Short- or long-term urinary retention (in which your bladder doesn’t empty completely)
  • Urinary tract infections
  • Bladder stones or damage
  • Kidney damage

BPH doesn’t lead to cancer. Some research suggests that it may actually have a protective effect against prostate cancer.

Prostate cancer tends to grow slowly. When caught in the earliest stages, the outlook is very good. The 5-year relative survival rate for prostate cancer that hasn’t spread, or has spread only to nearby areas, is 99%. The 5-year relative survival rate measures the percentage of people who’ll be alive 5 years after their diagnosis, no matter what their cause of death.

When cancer has already spread to distant sites by the time you’re diagnosed, the 5-year relative survival rate is 31%. (Because these rates are based on diagnoses reported from 2011- 2017, they may not reflect the most up-to-date treatments.)

Your doctor can tell you what your own outlook is likely to be.