Prostate Cancer Symptoms vs an Enlarged Prostate: What's the Difference?

Prostate cancer and an enlarged prostate (benign prostatic hyperplasia, or BPH) are two different conditions that can cause almost identical symptoms. Both affect the prostate gland that sits below the bladder, and both can lead to changes in urination as the gland presses on the urethra. One is a cancer, the other is not, and telling them apart is not something you can do from symptoms alone.

At St John & St Elizabeth Hospital, our urology team treats enlarged prostate and offers PSA testing and diagnostic pathways for both conditions, so if you are experiencing urinary symptoms, our private PSA test is a fast first step towards finding out what is causing them. We spoke to Consultant Urological Surgeon Mr Leye Ajayi about the symptoms of prostate cancer and an enlarged prostate, how they are tested and the treatment on offer.

What’s the difference between prostate cancer and an enlarged prostate?

An enlarged prostate happens when the gland’s cells grow in number over time, most commonly as a natural part of ageing. This growth is non-cancerous, but as the prostate enlarges, it can squeeze the urethra and make urination more difficult.

Prostate cancer develops when cells in the prostate grow and divide abnormally, forming a tumour. Depending on its size and location, a cancerous tumour can press on the urethra in a similar way to an enlarged prostate, which is why the two conditions can feel the same to the person experiencing them.

Having an enlarged prostate does not increase your risk of prostate cancer, and having one condition does not rule out the other. Because the symptoms overlap so closely, a PSA blood test and clinical assessment are needed to work out which is the underlying cause.

Symptoms of prostate cancer

Prostate cancer often causes no symptoms at all in its early stages, which is why many cases are picked up through routine PSA testing rather than because of how someone feels. When symptoms do appear, they can include:

• Needing to urinate more often, particularly at night
• Difficulty starting urination or a weak, interrupted flow
• A feeling that the bladder has not fully emptied
• An urgent need to pass urine
• Blood in the urine or semen
• Difficulty getting or maintaining an erection

Less commonly, if prostate cancer has spread beyond the prostate, it can cause bone pain, unexplained weight loss or fatigue. These are signs that should always be checked promptly. If you recognise any of these symptoms, a private PSA test at HJE gives you fast access to assessment and, if needed, further investigation with our consultant urologists.

Symptoms of an enlarged prostate (BPH)

An enlarged prostate tends to cause a more gradual set of urinary symptoms, sometimes called lower urinary tract symptoms (LUTS). These include:

• Needing to urinate more frequently, especially at night (nocturia)
• A weak or interrupted urine flow
• Straining or taking longer than usual to start urinating
• Dribbling after you think you have finished
• A feeling that your bladder has not emptied completely
• A sudden or urgent need to urinate

In some cases, an enlarged prostate can lead to acute urinary retention, a sudden inability to pass urine at all. This needs urgent medical attention.

Because these symptoms build gradually, many men put up with them for some time before seeking help. A PSA test alongside a clinical assessment can confirm whether an enlarged prostate is the cause, and our urology team offers treatments such as Aquablation Therapy for men diagnosed with BPH.

Why do the symptoms overlap?

The prostate surrounds part of the urethra, the tube that carries urine out of the body. Whether the gland is enlarging due to benign cell growth or due to a cancerous tumour, the effect on the urethra, and therefore on urination, can look very similar from the outside. The difference lies in the type of cell growth, not in how it presents day to day, which is exactly why testing rather than symptom-watching is the reliable way to tell the two apart.

When to see a doctor

If you have any of the milder symptoms, we advise arranging a check-up with your GP for peace of mind. Most urinary symptoms are not an emergency, but some signs should prompt you to seek help promptly:

• Blood in your urine or semen
• A sudden inability to urinate
• Unexplained bone pain, back pain or weight loss
• Any new urinary symptoms that last more than a few weeks

Both prostate cancer and an enlarged prostate become more common from around age 50 onwards, and risk is higher for men with a family history of prostate cancer or of Black ethnicity. If you fall into a higher-risk group, it is worth discussing PSA testing with your GP or a specialist even before symptoms appear.

How are they diagnosed?

Diagnosis for both conditions typically starts in the same way:

1. PSA blood test – measures the level of prostate-specific antigen in your blood. A raised result can indicate either condition or simply reflect a normal age-related change, which is why it is interpreted alongside other findings rather than on its own.
2. Clinical assessment, which may include a physical examination.
3. 3. Further investigation, where needed, such as an MRI scan or a prostate biopsy, to establish whether the cause is benign or cancerous.

At HJE, this pathway starts with our private PSA test, giving you prompt results and direct access to our consultant urology team if further assessment or treatment is needed.

Frequently asked questions

Can you have an enlarged prostate and prostate cancer at the same time?
Yes. One condition does not rule out the other, and some men are found to have both. This is part of why a PSA test and clinical assessment are used rather than relying on symptoms alone.

At what age do prostate symptoms usually start?
At any age, younger men can develop symptoms. However, both conditions become more common from around age 50, though risk factors such as family history or Black ethnicity can mean earlier or more frequent testing is worthwhile.

Do enlarged prostate symptoms get worse over time?
Left untreated, BPH symptoms often progress gradually as the prostate continues to enlarge with age. Treatment options, including medication and procedures such as Aquablation Therapy, can help manage or improve symptoms.