Two and a half years after we posted our blog on BPH’s role in suppressing prostate cancer (PCa) growth, a new study out of Beaumont Hospital School of Medicine (Royal Oak, MI) was published in the journal Prostate. It was good news for the authors of the 2019 paper discussed in our blog. It provided more evidence that “…patients with an enlarged prostate appear to have lower odds of significant prostate cancer.”[i] However, this second study approached the issue differently. Rather than the previous computer simulation of mechanobiological forces (that resist tumor) in the previous research, the Beaumont team turned to multiparametric MRI “to examine the association between quantitative prostate compositional metrics by magnetic resonance imaging (MRI) and PCa.”[ii] Their real-life findings support the computer simulation model. They record that for every cubic centimeter increase in the volume of the central gland, there’s about 3% less risk of significant PCa. They note the same for multifocal disease. Of course, this study raises the same dilemma as the earlier study: if you treat BPH with medication to reduce gland volume, do you then increase the risk of PCa growth? The authors caution that the potential value of BPH as a stabilizing PCa factor should be “further studied for risk stratification and in consideration for BPH therapy.” Check out our own 3-pronged strategy for addressing this problem, as described in the blog below.
If you have an enlarged prostate due to benign prostatic hyperplasia (BPH), you may have several reasons to be unhappy:
- Interrupted sleep from having to get up to pee
- Difficulty starting to pee
- More frequent urges during the day
- Slow stream or dribbling when you pee, etc.
None of this is any fun. You wonder, how much worse can it get? When should you seek medical help? Why is it even happening?
BPH restricts urine flow
BPH is the result of a natural change in the composition of prostate tissue that can occur with aging. The gradually enlarging prostate you have at age 55 is not the same one you had at age 20. Most men develop BPH, though not everyone is troubled by it. For those who are, the explanation is fairly simple: the tube (urethra) that carries urine out of the bladder passes directly through the middle of the prostate; since the prostate is nestled in a very confined space, as it grows it meets outer resistance, creating more pressure within the gland. This internal pressure squeezes and constricts the urethra, making it more difficult to pass urine. You know how your arm feels when a blood pressure cuff inflates and presses all around your arm? Think of a similar effect on the urethra as prostate tissue grows. In short, for men troubled by urinary symptoms, BPH is not their friend.
BPH may also restrict prostate cancer growth
While BPH may not be a man’s friend, a new study suggests it’s not cancer’s friend either. It has been noted in research studies that there is a correlation between prostate enlargement and slower growing prostate cancer (PCa), but no one knew exactly why. Now, a multinational team of researchers has demonstrated a plausible explanation. Using data from actual cases of men with BPH and PCa, the team used their imaging records (MRI) to generate a 3-D prostate simulation showing tumor locations.[iii]
According to a story out of Purdue University, “At the end of a one-year period, the simulations showed that the tumor of a patient with history of an enlarged prostate barely grew at all. When the researchers removed history of an enlarged prostate in the program, the tumor had grown to be over six times larger at the end of the same time period.”[iv]
Thus, over time the enlarging prostate exerts intense mechanical force not only on the urethra—to the chagrin of its owner—but could also restrict tumor growth by slowing the cancer’s own tumor formation. In other words, BPH may act like a natural obstacle, becoming an enemy of PCa activity and growth.
Treatment implications
Returning to the story from Purdue, if the above hypothesis holds up in future studies, “The findings suggest that it might be a bad idea to downsize an enlarged prostate through surgery or drugs, because doing so could lead to faster growth of prostate cancer.” What a dilemma this might create. For instance, a man whose BPH impairs his quality of life sees a doctor for relief, but in the process finds out he has prostate cancer. His cancer appears to be small and not aggressive, but if he takes medication or has a procedure to reduce the size of his gland in order to have better urinary function, will the cancer become larger or more aggressive, necessitating an aggressive treatment with a risk of incontinence? Is this a trade-off between problems?
And what about the problems of leaving an enlarged gland untreated? Continued enlargement is not predictable, but simply ignoring BPH can lead to other problems. Restricted or blocked urinary function may increase pressure in the bladder; urine retention (inability to pee) has been linked with urinary tract infections (UTI’s). Other complications include bleeding, kidney infection or kidney damage—all of which require treatment.
If ongoing research strengthens the theory that BPH suppresses prostate cancer growth, or if BPH alone is creating uncomfortable symptoms, the Sperling Prostate Center offers a three-pronged treatment approach that can resolve the dilemma for appropriate patients:
- Detection – Multiparametric MRI captures sophisticated, high resolution images of prostate anatomy as well as characterizing tissue differences. Using imaging alone, our expert team can deliver detailed information about the anatomy and location of both BPH and cancer tumors.
- Diagnosis – If any area is suspicious for PCa, we can do a real-time, in-bore prostate biopsy using a minimum number of needles targeted to the region of suspicion. The resulting tissue samples tell us the nature of any PCa picked up by the needles. At this point, we have all the information we need to develop a plan for MRI-guided treatment using Focal Laser Ablation (FLA).
- Treatment – MRI-guided FLA offers the perfect middle ground between undertreatment (don’t shrink the gland in order to restrict PCa growth) and overtreatment (surgically remove or radiate the whole gland to get rid of the BPH along with the cancer, but increase the risk of post-treatment urinary and sexual dysfunction). FLA is so precise that it can be targeted and shaped to destroy the PCa tumor, and also strategically reduce BPH without damaging the urethra or the neurovascular bundles that control sexual function.
There’s a saying: If the only tool you have is a hammer, you see every problem as a nail. Surgical procedures for BPH or PCa tend to clobber the whole gland, like hitting a thumb tack with a sledge hammer. The Sperling Prostate Center has a more adaptable tool kit, thanks to advanced MRI technology and the use of outpatient FLA.
I personally welcome further developments in the theory that BPH is a natural enemy of prostate cancer. Should this prove to be the case, we are already demonstrating that FLA is a safe and effective, yet flexible, treatment for both conditions—so our patients don’t have to put up with either. In this way, they can enjoy the high quality of life they have worked hard to attain.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.[i] i Beaumont Newsletter. “Researchers: Enlarged prostate lowers odds of significant prostate cancer.” Aug. 19, 2021. https://www.beaumont.org/health-wellness/press-releases/researchers-enlarged-prostate-lowers-odds-of-significant-prostate-cancer#:~:text=According%20to%20the%20studied%20MRI,in%20higher%20grade%20prostate%20cancer. [ii] Nandalur KR, Colvin R, Walker D, Nandalur SR, Seifman B, Gangwish D, Hafron J. Benign prostate hyperplasia as a potential protective factor against prostate cancer: Insights from a magnetic resonance imaging study of compositional characteristics. Prostate. 2021 Oct;81(14):1097-1104. [iii]Lorenzo G, Hughes T, Dominguez-Frojan P, Reali A, Gomez H. Computer simulations suggest that prostate enlargement due to benign prostatic hyperplasia mechanically impedes prostate cancer growth. PNAS January 22, 2019 116 (4) 1152-1161. https://www.pnas.org/content/116/4/1152.short?rss=1 [iv] Purdue University. “Enlarged prostate could actually be slowing tumor growth, simulations show.” MedicalXpress. Feb. 4, 2019. https://medicalxpress.com/news/2019-02-enlarged-prostate-tumor-growth-simulations.html
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
