For anyone experiencing lower urinary tract symptoms, the first concern is often prostate cancer. However, it’s important to stress that most prostate cancer cases are asymptomatic in their earliest stages. Instead, lower urinary tract symptoms in men are mostly caused by benign prostatic hyperplasia (BPH), a natural and very normal part of the aging process. BPH, or an enlarged prostate, is one of the most common conditions men face in the second half of life. About 50% of men experience symptoms by age 50, and by age 80, approximately 80% of men will have lower urinary tract symptoms due to prostate enlargement.
It’s Benign Now, But Does It Lead to Prostate Cancer?
Many men ask whether having BPH or an enlarged prostate increases their risk of prostate cancer. The short answer is no—BPH and prostate cancer are two distinct conditions, and one does not cause the other. These conditions tend to affect different parts of the prostate, which is why their symptoms also differ.
That said, it is possible to have both BPH and prostate cancer at the same time. This is why regular prostate cancer screenings are essential. If you are 50 or older—or younger with known risk factors for prostate cancer—you should discuss screening with your urologist.
What About My PSA Levels?
Prostate-specific antigen (PSA) testing has a long history in urology and prostate cancer diagnosis. However, in the past, we did not fully understand PSA and how to use it effectively. Today, however, PSA testing is a handy and very instructive tool.
While many patients become concerned about an elevated PSA level, it’s important to remember that aging itself, as well as an enlarged prostate, can naturally cause PSA to rise. Because of this, we no longer rely on strict PSA cut-offs to determine whether a biopsy is necessary. Instead, we use PSA trend testing, which involves multiple sequential PSA tests over time to monitor whether levels are rising rapidly.
Should I Be Worried About Prostate Cancer?
Prostate cancer is unique among cancers. Approximately 90% of prostate cancer cases are classified as low-grade disease, meaning they are unlikely to spread quickly and often require only active surveillance rather than immediate treatment.
However, a small percentage of prostate cancers are considered high-grade, meaning they have a significant risk of spreading to other organs. This is known as metastasis.
Discussing prostate cancer screening with your urologist is a crucial step in developing the right approach to monitoring and treatment. For most patients, treatment is simple and minimally invasive as their disease is caught at the low or intermediate grade. However, for those diagnosed with more aggressive forms of prostate cancer, early detection can significantly reduce the risk of life-threatening illness.
The Bottom Line
Some concerns have been raised in medical literature about over-screening for prostate cancer, as not all detected cancers are aggressive or life-threatening. However, with over 33,000 men dying from prostate cancer each year, our philosophy is simple:
Knowing the status of your prostate health is always better than uncertainty.
We believe in educating our patients about their diagnoses, discussing all available options, and providing reassurance when necessary. Whether monitoring low-grade prostate cancer or treating more aggressive cases, knowledge is power, and we are dedicated to guiding our patients through every step of the process.
