Prostate Health

BPH (benign prostatic hyperplasia) is non-cancerous enlargement of the prostate — it cannot become prostate cancer, and having BPH does not raise your cancer risk. Both can cause similar urinary symptoms (weak stream, frequency, getting up at night), which is why they are sometimes confused. Prostate cancer is a malignancy that may additionally cause bone pain, blood in semen, or erectile dysfunction in advanced stages. Distinguishing them requires a PSA blood test, digital rectal examination by a urologist, and sometimes an MRI and biopsy. A raised PSA does not automatically mean cancer — BPH, prostatitis, and even a urinary infection can raise PSA. A urologist interprets PSA in context.

In India, current guidance varies — most urologists recommend discussing PSA screening with your doctor from age 50 if you have average risk, or from age 40-45 if you have a first-degree relative with prostate cancer or are of African descent (higher risk groups). The PSA test has limitations: it can be falsely elevated (BPH, prostatitis, recent ejaculation, bicycle riding) and not all prostate cancers are aggressive. A single PSA above 4 ng/mL doesn't trigger immediate biopsy — the trajectory over time (velocity), PSA density, and MRI findings all inform the decision. The conversation is about informed shared decision-making with your doctor, not a blanket screen-everyone or screen-nobody approach.

Treatment depends on how much BPH symptoms affect your quality of life, not just prostate size. Mild symptoms: watchful waiting with lifestyle changes — reduce fluid in the evenings, limit caffeine and alcohol, double-void (urinate, wait a minute, urinate again). Moderate symptoms: alpha-blockers (tamsulosin, alfuzosin) relax prostate muscle within days to weeks; 5-alpha reductase inhibitors (finasteride, dutasteride) shrink the prostate over 6 months. Combination therapy works better than either alone for moderate-severe BPH. Severe symptoms or complications (urinary retention, bladder damage, recurrent infections): surgery — TURP (transurethral resection) remains the gold standard, with newer options including laser procedures, Urolift, and Rezum.

No — prostate cancer is a spectrum. Low-grade, localised prostate cancer (Gleason score 6) grows so slowly that many men with it die of other causes without it ever causing symptoms. This is why 'active surveillance' — regular PSA monitoring and repeat biopsies rather than immediate treatment — is a legitimate and guideline-supported option for low-risk localised cancer. Intermediate- and high-risk cancers need treatment: surgery (radical prostatectomy), radiation therapy (external beam or brachytherapy), and hormone therapy are all options. Advanced prostate cancer that has spread to bones is managed differently — hormone therapy, targeted drugs, and chemotherapy. Prognosis ranges from essentially curable (localised disease) to manageable for years (advanced disease).

Prostatitis is inflammation of the prostate — it has nothing to do with cancer risk and affects men of any age, most commonly 30-50. Acute bacterial prostatitis causes sudden fever, severe perineal and pelvic pain, and urinary symptoms — it needs urgent antibiotics (6-8 weeks) and sometimes hospital admission. Chronic bacterial prostatitis causes recurrent urinary infections and pelvic pain — treated with long-course antibiotics. Chronic pelvic pain syndrome (CPPS, previously called chronic non-bacterial prostatitis) is the most common form — it causes persistent pelvic, perineal, or penile pain without infection, and responds to a combination of alpha-blockers, anti-inflammatories, physiotherapy, and sometimes antidepressants or gabapentinoids for pain modulation.