A team of researchers studied the relationship between benign prostatic hyperplasia (BPH) and prostate cancer in 405 men by quantitatively looking at different parts of the prostate tissue on magnetic resonance imaging (MRI). Findings from their analysis were published by Nandalur et al in the journal The Prostate.
“People often confuse an enlarged prostate gland with cancer, given their symptoms, and believe increased size is due to abnormal growth,” said first study author Kiran R. Nandalur, MD, Vice Chief of Diagnostic Radiology and Molecular Imaging at Beaumont Hospital, Royal Oak. “On the contrary, our research showed patients with an enlarged prostate appear to have lower odds of significant prostate cancer.”
“Prostate MRI … is a powerful radiology test to look at the different anatomy of the prostate, specifically differentiating the central and outer aspects of the prostate gland, and also for underlying cancer,” Dr. Nandalur explained.
BPH is very common and often develops as men age; many have uncomfortable urinary symptoms, such as the frequent need to urinate or weak flow of urine. This is because the central part of the prostate enlarges with time from BPH and can obstruct urine leaving the bladder. Men often experience these symptoms and are concerned they have an underlying abnormality. When patients are told their symptoms are likely from an enlarged prostate due to BPH, which is benign, they often still have anxiety about whether this condition may increase their chances of cancer.
On multivariable analysis, higher central gland volumes were at lower odds of ≥ grade group 2 prostate cancer, taking into account peripheral zone volume and thickness. For every 1 cc increase in central gland volume, there was an approximately 3% decrease in the odds of finding ≥ grade group 2 prostate cancer. Similar findings were noted for multifocal disease.
“Previous studies are unclear whether BPH increases, decreases, or has no effect on prostate cancer risk,” said Dr. Nandalur. “Our findings should help reduce possible fears about significant prostate cancer when diagnosed with BPH, which is often misunderstood by the public. According to the studied MRI data, patients with BPH appear to have a potential protective factor against prostate cancer. The results may also explain why previous data have shown commonly prescribed drugs used to treat BPH may result in higher-grade prostate cancer. However, individualized management of a patient’s BPH is best determined after consultation with his physician.”
The study authors concluded, “Increasing central gland volume, driven by BPH, is associated with lower odds of significant prostate cancer, including multifocal disease, while peripheral zone anatomic and histologic surrogate changes were noncontributory. Findings support BPH impediment of global tumor growth predicted by a theoretical mechanobiologic model. This potential stabilizing factor should be further studied for risk stratification and in consideration for BPH therapy.”
Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.
