If you are experiencing complete urinary retention (inability to empty the bladder), fever/chills, heavy bleeding, or severe pain, contact emergency or urgent care immediately.

Key facts

  • BPH is a diagnosis of benign growth of the smooth muscle and epithelial cells in the prostate's transition zone1.
  • Urinary symptoms can come from BPH or from prostate cancer, and the two share overlapping symptoms2.
  • A urology guideline recommends PSA-based screening together with shared decision-making, with advice that depends on age and risk4.
  • Finasteride lowered average total PSA by about 50% in a small trial of men with BPH5.
  • In some small PAE studies, PSA levels fell after the procedure6,7. In one comparison, HoLEP lowered PSA more than PAE did8.
  • Talk with your doctor before you decide. This information does not replace personal medical advice.

What BPH is, and what it is not

BPH stands for benign prostatic hyperplasia. It is a diagnosis of growth of smooth muscle and epithelial cells within the prostate's transition zone1. Prostate cancer is a separate condition. Having one does not rule out the other: in a series of 82 men with prostate cancer who had PAE before radiation therapy, the median prostate volume before PAE was 90 cc and the median symptom score was 183. Those men were selected for PAE, so the numbers do not describe all men with prostate cancer.

This page does not say whether BPH itself raises or lowers the chance of developing cancer, because the sources it cites do not settle that. Cancer can also be found by chance in tissue removed during a TURP; an analysis of Australian trends suggested that less use of TURP may explain less incidental cancer detection in that tissue9.

Questions to ask

  • Has my prostate been checked for cancer, or only for enlargement?
  • Does having BPH change how often or how I should be screened?
  • If a procedure removes prostate tissue, will that tissue be examined?

Why this matters: "Enlarged" describes size, and "cancer" describes cells. Ask which one a test or an exam is measuring. For the size and anatomy words your report may use, see prostate size and anatomy terms.

Symptoms: why urinary symptoms do not tell them apart

Urinary symptoms are common in older men and can arise from BPH or from prostate cancer; the two conditions share overlapping symptoms2. Prostate cancer may also cause no symptoms at the early stage10, so the absence of urinary symptoms does not rule it out. In one study at a tertiary referral center in Tanzania, 133 men aged 50 or older with urinary symptoms who had a prostate biopsy were reviewed: 57.9% of biopsies were benign and 40.6% were malignant2. These men were already sent for biopsy and their average PSA was very high (mean 465 ng/mL), so those percentages are not a guide to any single man's chances. Men with prostate cancer can also have a large prostate and urinary symptoms; in the PAE series above, the median symptom score was 183.

Questions to ask

  • Which of my symptoms could come from BPH, and which would make you look for something else?
  • What tests, beyond a symptom questionnaire, would help separate the two for me?
  • Are my night-time or frequency symptoms a reason to check anything sooner?

Why this matters: A symptom score describes how bothersome symptoms are. In the biopsy study above, some symptoms were linked to cancer on biopsy, and the authors called for tissue evaluation in men with urinary symptoms in resource-limited settings2. Ask your own doctor which tests make sense for you. For one common symptom, see night-time and frequent urination.

PSA: how BPH, medicines and procedures can change it

PSA is a blood test used in prostate cancer screening. A benign enlarged prostate can itself raise PSA: in a small study of 80 men in Nigeria with symptomatic BPH confirmed on tissue, larger prostates went with higher PSA11. Finasteride is a 5-alpha reductase inhibitor, a type of BPH medicine. In a randomized trial of 40 men with BPH, finasteride lowered average total PSA from 3.0 to 1.5 ng/mL after 6 months, a 50% decrease5. In a large finasteride prevention trial, biopsy decisions used PSA values adjusted for the effect of finasteride; fewer men on finasteride had cancer overall (18.4% versus 24.4%), but higher-grade tumors (Gleason 7 to 10) were more common: 6.4% of men on finasteride versus 5.1% on placebo, which was 37.0% versus 22.2% of the tumors found. The authors write that the possible benefit must be weighed against sexual side effects and the increased risk of high-grade prostate cancer12. Do not stop a BPH medicine without talking with your doctor.

PSA can also change after a procedure. In a series of 10 men treated with PAE, PSA fell from 5.0 to 3.4 ng/mL at 12 months6. In 110 men followed for 6 months after PAE, PSA levels also improved significantly7. In a small comparison of PAE and HoLEP in men with prostates of 80 to 250 cc, HoLEP lowered PSA more at 3 and 12 months8. These studies are small, so ask what they mean for you.

Questions to ask

  • I take a BPH medicine. How should my PSA result be read?
  • If I have a BPH procedure, when should PSA be checked again, and what is my starting number?
  • Who will keep track of my PSA over time?

Why this matters: A PSA number means different things depending on medicines and procedures. Tell every clinician who orders the test what you take and what you have had done. For medicine choices, see BPH medication questions.

Screening: a decision to make with your doctor

A urology guideline recommends PSA-based prostate cancer screening together with shared decision-making. Its advice depends on age and risk: screening may begin with a baseline PSA test between ages 45 and 50, should be offered every 2 to 4 years at ages 50 to 69, and should be offered starting at age 40 to 45 for people at increased risk (Black ancestry, germline mutations, or a strong family history). The guideline also says the re-screening interval can be personalized, or screening stopped, based on preference, age, PSA, risk, life expectancy and general health, and that current population data support longer screening intervals and tailored screening4. This page gives questions, not a recommendation for any one man; ask whether this applies at your age.

Questions to ask

  • Should I be screened, and how often?
  • What would happen next if my PSA is high, and what are the downsides of acting on it?
  • Does my family history or my BPH change the plan?

Why this matters: Screening is a shared decision. Bring your own questions and preferences to the visit.

If you are considering a BPH procedure and worry about cancer

PAE has been studied for urinary symptoms in men who also have prostate cancer. A meta-analysis pooled 11 single-arm studies with 151 patients and rated the studies as having a high risk of bias13. In a study of 18 men with PI-RADS 3 or higher MRI findings, most of them biopsy-negative or judged not to need a biopsy, those findings were stable or lower on MRI after PAE; the authors stress that this does not imply cancer is cured by PAE, and that more work is needed on how reliable PI-RADS scoring is after PAE14.

Questions to ask

  • Has cancer been looked for before I choose a procedure for BPH?
  • If I already have a suspicious MRI finding or a prior biopsy, does that change which procedure makes sense?
  • If I have PAE, how will my MRI and PSA be interpreted afterward?

Why this matters: A lower PI-RADS score after PAE does not imply that cancer has been cured14. Ask the cancer question before the procedure, not after. See questions to ask before PAE and BPH treatment options.

Common questions

Can an enlarged prostate turn into cancer?

BPH is a diagnosis of benign prostate growth1, and prostate cancer is a separate condition. This page does not claim that BPH does or does not raise cancer risk, because the sources it cites do not settle that. What they do show is that a man can have a large prostate and urinary symptoms and also have prostate cancer3. Ask your doctor whether having BPH changes how you should be screened. Talk with your doctor before you decide.

Do BPH and prostate cancer have the same symptoms?

Urinary symptoms can come from BPH or from prostate cancer, and the two conditions share overlapping symptoms2. In one study of men aged 50 or older with urinary symptoms who were sent for prostate biopsy at a referral center in Tanzania, most biopsies were benign and a substantial minority showed cancer, and the men's average PSA was very high; the authors called for tissue evaluation in men with urinary symptoms in resource-limited settings2. Early prostate cancer may also cause no symptoms10. Ask your doctor what tests would tell them apart for you. Talk with your doctor before you decide.

Does PAE lower PSA?

In some small PAE studies, PSA levels fell after the procedure, for example from 5.0 to 3.4 ng/mL at 12 months in a series of 10 men6. In 110 men followed for 6 months, PSA also improved significantly7. In one comparison, HoLEP lowered PSA more than PAE did8. Ask your doctor how a PSA result should be read after any prostate procedure. Talk with your doctor before you decide.

Do BPH medicines change PSA?

Finasteride, a 5-alpha reductase inhibitor, lowered average total PSA by about 50% over 6 months in a small trial of men with BPH5. A large prevention trial used PSA values adjusted for finasteride's effect when deciding on biopsy12. Tumors of Gleason grade 7 to 10 were found in 6.4% of men on finasteride versus 5.1% on placebo12. Do not stop a BPH medicine without talking with your doctor. Tell every clinician who orders a PSA test which prostate medicines you take. Talk with your doctor before you decide.

Should I be screened for prostate cancer if I have BPH?

A urology guideline recommends PSA-based prostate cancer screening together with shared decision-making, with advice that depends on age and risk: it says screening should be offered every 2 to 4 years at ages 50 to 69, and earlier for people at increased risk. It also says current data support longer and more tailored screening intervals4. Ask whether screening applies at your age. Whether and how to be screened is a decision to make with your doctor. Talk with your doctor before you decide.

Talk with your doctor before you decide. This information does not replace personal medical advice. Read the medical disclaimer.

Sources

  1. Lerner et al., J Urol 2021, AUA guideline on lower urinary tract symptoms attributed to BPH, Part I (PMID 34384237) ↩︎
  2. Amin et al., J Clin Med 2026, BPH and prostate cancer among men with urinary symptoms (PMID 42074717) ↩︎
  3. Khatri et al., Clin Transl Radiat Oncol 2025, PAE before prostate radiation therapy (PMID 41122670) ↩︎
  4. Wei et al., J Urol 2023, AUA/SUO guideline on early detection of prostate cancer, Part I (PMID 37096582) ↩︎
  5. Pannek et al., J Urol 1998, finasteride and free and total PSA in men with BPH (PMID 9649261) ↩︎
  6. Iossa et al., J Clin Med 2025, PAE case series and narrative review (PMID 40507540) ↩︎
  7. Wu et al., Eur J Radiol 2026, PAE outcomes in a Taiwanese cohort (PMID 42561892) ↩︎
  8. Bhatia et al., World J Urol 2026, HOPE trial of PAE versus HoLEP (PMID 41528505) ↩︎
  9. Pathirana et al., Cancer Epidemiol 2022, PSA testing and prostate cancer trends in Australia (PMID 35026706) ↩︎
  10. Rawla, World J Oncol 2019, epidemiology of prostate cancer (PMID 31068988) ↩︎
  11. Aigbe et al., Niger J Clin Pract 2022, prostate volume and PSA in men with symptomatic BPH (PMID 36149214) ↩︎
  12. Thompson et al., N Engl J Med 2003, finasteride and the development of prostate cancer (PMID 12824459) ↩︎
  13. Lucas-Cava et al., Cardiovasc Intervent Radiol 2025, PAE in patients with prostate cancer, systematic review and meta-analysis (PMID 40640416) ↩︎
  14. Bossi Croci et al., Br J Radiol 2026, PI-RADS 3-5 lesions on MRI after PAE (PMID 41832960) ↩︎