Is An Enlarged Prostate Gland Concerning For Cancer?

No.  This is more likely to be a result of BPH or benign prostatic hyperplasia.  This is an increase in the number of cells in the prostate centrally.  This is where the urethra is positioned within the prostate.   The urethra is where urine goes from the bladder.

What is the most common cause of prostate gland enlargement?

Benign prostatic hyperplasia is seen in a majority of elderly men, so it can be considered a normal part of aging.  This can result in urinary symptoms like weak stream, incomplete emptying of the bladder and having to go at night.  Enlarged prostate can also result in elevation of PSA values.  This is a blood test that can identify abnormalities of the prostate like cancer.

How do we know the gland is enlarged?

An enlarged prostate is often defined as having a volume of greater then 30 cc.  An experienced radiologist can often identify an enlarged gland by simply eyeballing it.  The enlarged gland can be identified on a variety of imaging tests like ultrasound, CT and MRI.

Enlarged gland and correlation with PSA

Some radiologists will suggest correlation with PSA values for an enlarged gland.  Unfortunately,  PSA values can be elevated in cancer, inflammation, and enlargement.  So that usually does not help very much.

What do we do next for an enlarged gland?

Further imaging with prostate MRI can be done to further look at the enlarged prostate gland.  The enlargement of the gland will often be from enlargement in the transitional zone or central prostate.  There will be nodules and heterogeneity in this region. Cancer often occurs in the peripheral part of the gland.

Prostate MRI will often help tell us if an enlarged gland has a clinically significant cancer.  That is one, which may shorten a patients life or one which needs treatment.  Prostate MRI is good at detecting cancers in the peripheral zone, but not so much in the central gland where the hyperplasia occurs.

Does Prostate MRI always tell us the reason for enlargement of the gland?

Prostate MRI can not identify all cancers.  While it can tell us that the enlargement of the gland is from benign hyperplasia, it can sometimes not identify cancers.   Some of the features of inflammation and benign hyperplasia can look like cancer.  While cancer can hide in the gland and look like a more benign abnormality, especially where hyperplasia occurs centrally in the gland.

An enlarged gland is therefore not from cancer most of the time.  It’s a normal part of aging to have an enlarged gland since the majority of elderly men have one.  In rare cases, a big prostate tumor can cause enlargement of the gland.  This may sometimes be obvious on imaging such as CT, especially if it invaded other organs or spreads to distant sites.