Condition Comparison

BPH (Enlarged Prostate) vs Prostate Cancer

Same symptoms, different conditions: here's exactly how to tell them apart.

BPH (Enlarged Prostate)

Benign Prostatic Hyperplasia: a non-cancerous enlargement of the prostate gland. Extremely common in men over 50. Affects urination but is not life-threatening.

VS

Prostate Cancer

A malignant tumour of the prostate. The most common cancer in Nigerian men. Often slow-growing and curable if caught early, but aggressive if detected late.

Side-by-Side Comparison

FeatureBPH (Enlarged Prostate)Prostate Cancer
NatureBenign (non-cancerous)Malignant (cancerous); can spread to bones and lymph nodes
Age of onsetCommon from 50; nearly universal by 80Rare under 50; peak diagnosis 60–75
Urinary symptomsWeak stream, frequency, urgency, nocturia, incomplete emptyingSame symptoms as BPH: cannot distinguish clinically
PSA levelMildly elevated (usually 4–10 ng/mL proportional to size)Often higher (>10 ng/mL) or disproportionate to gland size; rising PSA is a red flag
Rectal examination (DRE)Smooth, symmetrically enlarged prostate; rubbery textureAsymmetric, nodular, or hard areas: hard nodule is cancer until proven otherwise
Ultrasound appearanceHomogeneous enlarged gland; large post-void residual urineHypoechoic (dark) lesion at peripheral zone; asymmetry
Bone painNever (BPH does not spread)Lower back, hip, or pelvic bone pain = possible metastasis; very concerning
Blood in urine/semenUncommon (can occur with prostatitis)Can occur; blood in semen (haematospermia) warrants evaluation
Treatable?Yes, alpha-blockers, 5-alpha reductase inhibitors, TURP surgeryYes if caught early: surgery, radiotherapy, hormone therapy, surveillance

Symptoms They Share

⚠️ Both conditions can cause:

  • Weak or slow urinary stream
  • Difficulty starting urination
  • Frequent urination, especially at night (nocturia)
  • Feeling of incomplete bladder emptying
  • Urgent need to urinate
  • Elevated PSA blood test

The Key Difference

💡 How to tell them apart

Symptoms alone cannot distinguish BPH from prostate cancer: both cause identical lower urinary tract symptoms. This is why testing is non-negotiable for men over 50. The critical red flags that raise cancer suspicion above BPH are: a PSA disproportionately high for the gland size, a rapidly rising PSA over 6–12 months (velocity >0.75 ng/mL/year), a hard or nodular prostate on rectal examination, and, most ominously, new onset lower back or hip pain with urinary symptoms (which may indicate bone metastasis). Early prostate cancer is highly curable; late-stage disease is not. A PSA test at 50 (or 45 for men with family history or of African descent) can be life-saving.

Which Tests Diagnose Each?

🧪 PSA Blood Test (Prostate-Specific Antigen)
The primary screening test. PSA is a protein made by prostate cells, both normal and cancerous. Elevated PSA does not mean cancer (BPH, prostatitis, and recent ejaculation also raise it), but high or rising PSA demands further investigation.
🧪 Prostate Ultrasound (TRUS)
Measures exact prostate volume, identifies hypoechoic lesions suspicious for cancer, calculates PSA density (PSA ÷ volume), and measures post-void residual urine. Available at Mascot Healthcare.
🧪 Digital Rectal Examination (DRE)
A 30-second clinical examination where a doctor palpates the prostate through the rectum. Detects hard nodules, asymmetry, or fixation that suggest cancer, even with normal PSA.
🧪 Prostate Biopsy (TRUS-guided)
If PSA and/or DRE are concerning, a transrectal ultrasound-guided biopsy takes 8–12 tissue cores for pathology. The Gleason score from biopsy determines cancer grade and guides treatment decisions.

Frequently Asked Questions

Does an enlarged prostate always mean cancer?
No. BPH is entirely benign: the cells multiply but they are normal cells, not cancerous. Having BPH does not increase your risk of developing prostate cancer. However, because BPH and early prostate cancer can look identical symptomatically, regular PSA checks are essential for all men over 50.
My PSA is 6 ng/mL. Should I be worried?
A PSA of 6 is above the traditional normal of 4, but context matters enormously. A 70-year-old with a 100g prostate and a PSA of 6 has a low PSA density, less worrying. A 55-year-old with a 25g prostate and a PSA of 6 has a high PSA density, more concerning. The trend over time is also critical. Please see a doctor for interpretation rather than relying on the number alone.
Is prostate cancer common in Nigerian men?
Very common: prostate cancer is the most frequently diagnosed cancer among Nigerian men and accounts for a significant proportion of cancer deaths. Men of African descent have the highest prostate cancer risk globally. Yet the majority of cases are caught late because men avoid checking. A simple PSA blood test could catch it early when it is entirely curable.
Can I have sex after a PSA test?
Ejaculation temporarily raises PSA by 0.4–0.8 ng/mL. To get an accurate baseline, avoid ejaculation for 48 hours before the test. Vigorous cycling and prostate massage also transiently raise PSA and should be avoided beforehand.

Not sure which one you have?

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Last updated 16 October 2026.