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What do you make of this? It says that because the transition zone enlarges in BPH, it compresses the peripheral zone changing the morphology thereby making it less prone to becoming cancerous. The larger the prostate the less the probability of a positive biopsy therefore, people with BPH should not take drugs like finasteride.
It's harder for a biopsy sample to find PCa in a large prostate than in a small one. PSA density (PSA divided by prostate size) is a risk factor for detecting cancer. Finasteride increases the detection rate by shrinking the prostate. PSA and mpMRI become better predictors of PCa after shrinking the prostate:
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The author makes the mistake of seeing the association and inferring causation (" that BPH size may be protective of PCa"), instead of the more obvious conclusion that larger prostate size makes it more difficult to detect the cancer that is in there.
At the time of simple prostatectomy in 2014, my husband's prostate was over 150 grams. He had had 11 years of negative biopsies. Not one of 4 uros, including V. Patel in Celebration, recommended MRI-guided at a PSA of 14. His tumor was in the transition zone. He had a severe reaction to the first dose of Finasteride so was on Rapaflo which does not reduce the size of the prostate, for years.
Your husband's history is bizarre. He didn't have cancer yet had his prostate surgically removed because of BPH. He never had a biopsy yet he had 39 sessions of IMRT, he was never on lupron yet was on casodex and taxotere and did not have metastases. Perhaps the article is right, his BPH protected him from prostate cancer. Somebody jump in and explain this to me. Thanks.
Maybe you don't know what a simple prostatectomy is??? He didn't have IMRT as primary. That was for salvage treatment after 2 failed surgeries. He NEVER had taxotere. he's not metastatic. He had a simple prostatectomy because his prostate was so large it cut off his urethra. He was catheterized for 4 months prior to the prostatectomy. "He never had a biopsy yet he had 39 sessions of IMRT. Excuse me, but where the heck did you get that? I clearly said that he had had 11 years of negative biopsies. The BPH did not protect him. It delayed treatment for 11 years. Because of BPH, he had 2 surgeries, 2.5 years of bical + 39 RT. BPH does NOT work in favor of those with PCa.
I apologize for insensitive way I responded to your post. Obviously, he has been through a lot. I meant to say he never had a positive biopsy. The pathology report said he had an area of Gleason 6 but my understanding is that Gleason 6 does not spread and does not require treatment. Nevertheless, he was treated with drugs and IMRT based solely on a rising PSA. I am not a doctor but in my opinion, he should have had a biopsy to see if he had cancer or if the rising PSA was due to benign prostate tissue remaining after the surgery.
Original pathology from the "simple" was G 6. After PSA continued to rise from 2014 surgery, he had a MRI-guided biopsy that returned 1 core of 4 a G7 (3+4). After. A salvage surgery was done, no cancer found, but it was still there because PSA continued to rise and the F-18 DCFPyL (Pylarify in trial at Stanford) identified recurrence in the prostate bed, seminal vesicles. Subsequently, Kwon (Mayo RST) upgraded the G 3+4 to G 4+3. I have excellent reason to doubt Kwon's findings, but there it stands because he continued with 2.5 years of bical + 39 RT which I don't think were whole pelvic. We wait. And now we have way bigger fish to fry with the CLL.
This looks like a retrospective look at other papers. Not a new finding. I might have misread it
The article referenced studies involving thousands of men. The authors didn't state BPH prevents PCa. It found statistical evidence of a reduction of diagnosed PCa in men with BPH vs. men without BPH. You can't argue with the statistics, but you can argue as Tall Allen has that it was due to biopsy sampling errors due to the increased size of the prostate.
Thanks for your response. Prostate cancer is found in the transition zone about 20% of the time, the central zone about 5% of the time and peripheral zone about 75% of the time. Therefore, yes the transition zone is less prone to develop cancer.
Very interesting:
BPH may be protective against prostatic cancer
and
...
“the shrinkage of the prostate induced by 5ARIs [such as by using Finasteride ] reduced the hydrostatic stress that had accumulated over years of BPH in prostatic tissue, which led to a mechanical state that favored the development of PCa”.
...
Please share your \"doctor hero\" stories.
Why no testosterone monitoring?
High Gleason, Low PSA
Coffee and PCa question
Newly Diagnosed Prostate Cancer. Gleason score 9, PSA 1.4 at age 58.
