THE ASSOCIATION OF BENIGN PROSTATIC HYPERPLASIA AND CANCER OF THE PROSTATE

There are a number of similarities between benign prostatic hyperplasia [BPH] and cancer. Both display a parallel increase in prevalence with patient age according to autopsy studies [86.2% and 43.6%, respectively, by the ninth decade], although cancer lags by 15-20 years. Both require androgens for growth and development, and both respond to antiandrogen treatment regimens. Most cancers arise in prostates with concomitant BPH [83.3%], and cancer is found incidentally in a significant number of transurethral prostatectomy [TURP] specimens [10%]. The clinical incidence of cancer arising in patients with surgically treated BPH is approximately 3%. BPH may be related to a subset of prostate cancer which arises in the transition zone, perhaps in association with atypical adenomatous hyperplasia [AAH]. It is important to exclude cancer in patients presenting with symptoms of bladder outlet obstruction presumably due to BPH. For such patients, we recommend digital rectal examination [DRE] and, at least in high-risk patients, serum prostate specific antigen [PSA] determination. Transrectal ultrasound [TRUS] should be employed in patients with elevated PSA levels to determine the volume of the prostate, the relative contribution of BPH to volume, and the PSA density [ratio of PSA level to volume]. Biopsy should be obtained from any area suspicious for cancer. Early detection and treatment of cancer when it is localized offers the greatest chance for cure.