What's the difference between typical BPH symptoms and symptoms of prostate cancer?

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I've had BPH symptoms for over year. My urologist did a DR E and didn't think I had prostate cancer ( had a PSA about a year and a half it was normal). I've only had typical BPH symptoms (obstruction and retention which is getting worse) however in the back of my mind I think what if it's actually prostate cancer. Would I have other symptoms if I had prostate cancer and would different symptoms occur within one year?

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  • Posted

    How old you Johnny ? DRE and PsA are good marker points but not conclusive . BPH is far more common than PC and with a low PSA ( may be worth having another one to measure any change) and normal DRE, i would think Pc unlikely but for your own piece of mind may be worth having other tests such as a pelvic MRI ?

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  • Posted

    A very good question. If you know for certain that you have an enlarged prostate due to BPH then the usual tests for prostate cancer are not reliable. Instead there are modified guidelines that can be used.

    An important one is the simple DRE where your doctor just feels for any lumps on the outer layers of the prostate where most cancerous lesions form.

    Another test is to monitor your PSA DENSITY over time and not your PSA. This is because PSA activity is related to the size of the prostate gland so you could have an elevated PSA just because your prostate is larger than a normal one of about 30 cc.

    The PSA density is just your PSA divided by the gland size. This value should be less than 0.1 . In my case my PSA is 25 and my prostate size is 300 cc so my PSA density is well below this value.

    Also prostate cancer over time will show an increasing trend line for this value whereas BPH just moves up and down over time.

    Another important indicator of prostate cancer is your serum Free PSA which can be measured at the same time as your PSA. This value should be above 18%. When cancer is present the free PSA produced by the prostate is used by the cancer cells so the serum value will be low. In my case the number is 36%.

    These are good simple tests but if they ever raise a warning sign then the next step would be a 3T MRI with dynamic contrast to show the presence of any lesions that could be biopsied. I had an MRI 2 years ago and it showed a suspicious lesion which was then biopsied and turned out to just be inflammation associated with a recent PAE procedure.

    Never ever submit to a blind biopsy where they jst go in and take pieces of your prostate for testing. Most men as they age will have miscroscopic cancer cells in their prostate but it will likely never become clinically significant. Howard

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    • Posted

      Howard gives an excellent answer here

      Spot on and informative

      Also consider 4Kscore (blood test) and MiPS (urine test) as these will provide cancer risk in terms of probability of having cancer and having aggressive cancer (Gleason 7 or higher)

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    • Posted

      Thanks Michael and thanks for bringing up the so-called liquid biopsy tests for prostate cancer. Again with these tests it is really important to know that they are designed for men with normal sized prostates. This is because they use the PSA value as part of their algorithm that computes a 'score" which gives the probability of having prostate cancer.

      These liquid biopsies were created to screen men who have PSA s in the "gray" area between 4 and 10. In the past doctors would just order blind TRUS biopsies of the prostate when the PSA was over 4. So these liquid biopsies are a screening for whether or not to do these biopsies. But if the PSA is over 10 and the prostate is normal size then these tests usually tell the men to either get an MRI or a TRUS biopsy.

      In my case I recently had one of these tests and the results came back that I had over a 94% chance of Gleason 7!! But then my urologist had failed to include my prostate size of 300gm (10 times normal) and rather just included my PSA of 36. So of course the computer was smoking!

      The people who design these tests say they do use a different algorithm for BPH patients which I think is based on PSA density rather than just PSA. Apparently they are re-running my test but I haven't heard back. Anyway next week i am scheduled for a 3T MRI with dynamic contrast.

      The bottom line is that if you do try one of these liquid biopsies ( so called because they use either urine or blood ) then make sure to let them know you have BPH and ask if their algorithm adjusts fr that. Howard

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    • Posted

      Howard,

      "Liquid biopsy" is an apt moniker. ๐Ÿ˜ƒ

      There are websites that use algorithms to calculate (i) total cancer risk and (ii) Gleason 7+ cancer risk based on various parameters (PSA, % free PSA, PSA density, PHI, PCA3, prostate volume, DRE results, negative prior biopsy, time span since prior negative biopsy, family history, race, etc.).

      I think, like you, my large prostate tends to produce low overall probability for G7 or higher (<10%) when I plug data into the various risk calculators.

      BTW, if you play with the algorithms (i.e., keep all variables constant but change prostate volume - the range in volume is pretty limited, i.e., no calculator will allow you to enter 300 cc [volume measurement in cc, not grams, a mass measurement, although the density of water (1 g/cc) is typically assumed when discussing the prostate]) - you will notice % probability of cancer decreases as prostate volume increases, so the algorithms have built within them an inverse relationship between size and risk, thus accounting for the impacts of BPH on total PSA.

      Michael

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    • Posted

      Thanks Michael - that is really important information. Could you please PM me with a link to your favorite algorithm?

      I plan to start a new thread after my MRI next week on BPH and prostate cancer ( hoping for negative results!).

      There is a lot of research that tries to tie together prostatitis, BPH and prostate cancer as a natural progression towards cancer. The premise is that acute prostatitis leads to chronic prostatitis (if untreated right away) which then leads to chronic inflammation and glandular cell proliferation (BPH) which then leads to cancer via the increased probability of genetic mutations in all that hyperplasia. I personally believe that BPh is an auto-immune disease but that is another story.

      In my case I never ever had an peeing problems until 1996 ( 48 then) and in fact did not even know what a prostate was. But then my family doctor at the time suggested I get a PSA test which was 0.9 so he sent me to a uro who conducted a very unsanitary blind biopsy. Needless to say i got prostatitis from that procedure which I believe started me on the path to BPH.

      Thanks again. Howard

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  • Posted

    Have another PSA test. If it hasn't increased much from last one, you don't have PC. Hank

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    • Posted

      I had a PSA test 3 months ago and it was 22. I had one 2 months ago and it was 36. I had one last week and it was 25. PSA tests are not reliable for BPH patients and should be avoided. Free PSA and PSA density are important to monitor but not simple PSA tests. Those tests are designed to detect prostate cancer for men with normal size prostates.

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  • Posted

    DREs, PSAs, Free PSAs, Ultrasounds all iffy. MRI will probably detect any PCa but then an ultrasound-guided Biopsy of MRI detected spot/s is next step. There is still doubt over whether positive biopsy hits cause PCa to spread. Post Radical Prostatectomy obstructions and incontinence may be worse than the BPH. If Uro doesnโ€™t press you may be better off not knowing.

    Barrie

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    • Posted

      I respectfully disagree. If there is a cancerous lesion just under the capsule and it breaks through and becomes metastatic then the patient is dead. That is how most men die from prostate cancer.

      If the MRI shows suspicious lesions, especially in the peripheral regions of the gland close to the capsule, and a targeted biopsy confirms a certain Gleason level, then the FLA procedure as well as other targeted procedures have proven safe and effective in saving the lives of a great many men. Knowledge is power. Howard

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    • Posted

      Agree here w/ Howard: if the MRI shows something and the radiologist assigns a PIRADs 4 or 5 for the suspect lesion, proceed to an MRI-guided fusion (MRI imaging is used for better mapping of needles) biopsy. Do not mess with a score of 4 or 5.

      PIRADs 3 is indeterminant and perhaps other tests can be used in decision-making.

      And make sure the MRI is done on a 3-Tesla machine, as these offer the best imaging available.

      Lesions closer to the capsular wall are a greater concern. Prostate cancer is highly curable within the capsule.

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    • Posted

      Two years my MRI showed what was rated as a PIRADs 4 7mm lesion just inside the capsule. A local urologist wanted to do the fusion biopsy using the MRI images to guide his ultrasound saturation biopsy. He wanted to take 32 cores in the region!! No doubt as Barrie suggests if there was cancer he would possibly spread it around!!

      I was very lucky then to meet Dr. K in Houston and uploaded my CD to him. He said that it would be near impossible to use an old MRI image on a prostate my size to u/s guide the biopsy needle to hit a 7mm lesion. So I flew down to Houston and Dr. K conducted a real-time in bore MRI-guided biopsy of the lesion and successfully took out 4 cores from it through a tube that would not allow any potential cancer cells to spread. Fortunately then it was just inflammation so the PIRADS 4 score was reasonable but wrong. Now I have my 2 year follow-up MRI to check on it. By the way, the inflammation was traced to a PAE procedure I had had 3 months earlier. Since inflammation can be a precursor to cancer there is a noteworthy warning there regarding arterial embolization procedures in general but that is another story. Howard

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    • Posted

      Wow, great story Howard.

      It does tell us three things: (1) check out a PIRADs 4 or 5 and don't leave it to chance; (2) there are good options to saturation biopsies; (3) Dr K is one special doc and a great guy.

      ๐Ÿ˜ƒ

      Glad it was inflammation, not cancer.

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