Prostate enlargement vs prostatitis vs prostate cancer — what's the difference?

Diseases of the prostate include prostate enlargement (often referred to as benign prostatic hyperplasia or BPH), prostatitis (inflammation of the prostate) and prostate cancer, which is the most common cancer diagnosed in Australian men.

Here's what you need to know about these common prostate problems and what you can do about them.

Prostate enlargement

Prostate enlargement or benign prostatic hyperplasia (BPH) is a normal part of aging for some men. It affects about 8% of men in their 30s, 25% of men in their 50s, 33% in their 60s and about 50% of men over 80². Because prostate enlargement places pressure on the urethra, it usually causes trouble with urination. Men with BPH can feel the need to urinate more often or with more urgency than usual — this is especially noticeable during the night. BPH can also cause a weak urine stream and the inability to completely empty the bladder.

The symptoms of prostate enlargement can be inconvenient, limit daily activities, and cause considerable stress and anxiety. Complications that can arise from BPH include urinary retention, impaired kidney function, urinary tract infections, bladder stones and blood in the urine.

Treatment options for BPH vary depending on its severity and how much it affects daily life. Men with mild symptoms may opt to do nothing or make lifestyle changes. Other treatment options for BPH include medication and surgery. 

Medications can reduce the size of the prostate in men with mild or moderate BPH but these may not relieve all symptoms. A variety of surgical options are available for moderate or severe prostate enlargement, each with its own benefits and side effects.

Prostatitis

Discomfort or pain in and around the prostate may be caused by inflammation (prostatitis).

Usually, prostatitis is caused by a bacterial infection that is easy to diagnose and treat but if it’s not dealt with quickly, bacterial prostatitis can be life-threatening. Recurring bacterial prostatitis can be caused by some underlying prostate problem, such as BPH or repeated urinary tract infections.

In some cases, the prostate can be inflamed without bacterial infection. The cause of this type of prostatitis is unknown. It may come and go, and worsen with stress.

Bacterial prostatitis can be treated with antibiotics. Medicine to relax the muscle in the upper part of the urethra (where the prostate surrounds it) can be effective in relieving the pain of prostatitis. Prostate massage and pelvic floor exercises may also help relieve the pain of prostatitis. Surgery is an option for removing sources of infection that contribute to prostatitis.

The pain of prostatitis, and uncertainty about whether it will go away, can lead to a sense of hopelessness and depression. Prostatitis can reduce libido (sex drive) and fertility can decrease because production of prostate fluid, which protects and supports sperm, can be reduced and/or sperm may be damaged by bacteria. Experts are undecided about whether prostatitis leads to prostate cancer.

Prostate enlargement and prostatitis are not signs of prostate cancer, which is the growth of abnormal prostate cells. 

Prostate cancer

Prostate cancer is most commonly diagnosed in men aged over 50 years. About two-thirds of cases in Australia are diagnosed in men over 65, and one in five Australian men aged 85 or over has prostate cancer.

Prostate cancer may be localised (no abnormal cells outside the prostate) or advanced (abnormal cells have moved into the tissues and organs around the prostate or further into the body e.g. in the lymph nodes or bones).

Some prostate cancers detected in the early stage grow slowly, so may never pose a risk to the health or lifespan of many men. Ninety-five per cent of men who are diagnosed with prostate cancer are still alive five years later³. The eventual cause of death for most men with prostate cancer is something completely unrelated.

Localised prostate cancer can have no symptoms in some men. Others may have urinary problems like men with BPH. Men with advanced prostate cancer may have blood in their urine and can have pain in their lower back, pelvis and thighs.

There is no simple test for prostate cancer. A blood test for prostate specific antigen (a substance made by normal and abnormal prostate cells) can be used and a digital rectal examination (DRE) can be performed to identify abnormal prostate size, shape or texture. Results of these tests help indicate the risk of prostate cancer but these tests alone are not enough for diagnosis.

A prostate biopsy (collection of samples of prostate tissue) is required for cancer diagnosis but this procedure is not perfect at detecting cancer and has its own risks. Prostate biopsy can result in bleeding (resulting in blood in urine and/or semen), infections, and temporary (lasting up to six months) problems with urination or erections.

Based on the biopsy examination, prostate cancers are classified in terms of their grade (an indication of how quickly the cancer may grow). Medical imaging (like an MRI, x-ray or ultrasound) is also required to assess cancer stage (i.e. localised or advanced).

In some cases, biopsy can detect prostate cancers that would never actually cause harm. The detection of low-grade, low-stage prostate cancers presents a challenge as prostate cancer treatments (surgery, radiation therapy, chemotherapy or hormone reduction) have side effects and risks that may be worse than the consequences of the cancer itself. Surgery and radiotherapy can result in erectile dysfunction and urinary incontinence; radiotherapy can result in bowel problems and temporary infertility. Men, in consultation with their healthcare providers, need to decide on a course of management that suits them.

‘Active surveillance’ of prostate cancer may be preferable to treatment for men with low-grade cancers, for whom prostate cancer may never have a physical impact on their lives. ‘Active surveillance’ involves regular PSA blood tests, examinations, scans and repeated biopsy procedures. ‘Watchful waiting’ might be suggested to some men, which involves fewer tests than active surveillance. These approaches to managing prostate cancer can avoid the complications of treatment but may have a psychological impact for those men, who live knowing they have the disease.

Although your genetics play a large part in the development of prostate disease, keeping on top of your health, and seeing your doctor when something doesn’t seem right, is the most important thing you can do for your health.