BPH vs prostate CA

[cableguy]

Any tips for the best ways of distinguishing between these two? Of course a palpable prostate nodule would be suspicious, but what about just an enlarged prostate in general?

Its my understanding that PSA can be elevated with both, and generally CA PSA would be higher value but that there is also an overlap between PSA values for BPH and prostate CA. So doesn't that limit the utility of PSA?

Another thought. Given that BPH is a relatively common condition and benign for the most part, it doesn't seem feasible to w/u every enlarged prostate that comes thru your office due to cost and potential invasiveness.

So how would you experienced clinicians proceed when you discover an enlarged prostate via DRE?

Thanks in advance,

-will

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[StickMe]

I'm certainly not an experienced clinician at this point, but I would first talk to my patient. Prostate cancer is often asymptomatic until late in the disease while men with BPH are usually annoyed by their symptoms enough to notice something. You could also order a % Free PSA. A low free psa, I would definitely be doing a biopsy; a high one and I'd have to look at the bigger picture I guess.

 

[tugbug]

Any tips for the best ways of distinguishing between these two? Of course a palpable prostate nodule would be suspicious, but what about just an enlarged prostate in general?

Its my understanding that PSA can be elevated with both, and generally CA PSA would be higher value but that there is also an overlap between PSA values for BPH and prostate CA. So doesn't that limit the utility of PSA?

Another thought. Given that BPH is a relatively common condition and benign for the most part, it doesn't seem feasible to w/u every enlarged prostate that comes thru your office due to cost and potential invasiveness.

So how would you experienced clinicians proceed when you discover an enlarged prostate via DRE?

Thanks in advance,

-will

As someone who plans to make a career out of urologic surgery, I would recommend the patient proceed directly to the OR for prostatectomy! I plan to recommend that to all of my patients, regardless of what I note on DRE. We don't want to miss a cancer!