Several medical conditions can mimic prostate cancer, causing many of the same symptoms, including painful ejaculation and blood in the urine. Some of these conditions can also cause elevated prostate-specific antigen (PSA) levels in the same way as prostate cancer or have a similar appearance on diagnostic imaging.
It’s crucial to distinguish between these conditions to ensure the appropriate treatment.
1. Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH) is the medical term for an enlarged prostate. This benign (non-cancerous) condition can cause many of the same symptoms of prostate cancer, including:
- Frequent urination
- Trouble starting or stopping urination
- A weak urine stream
- Pain with urination
- Bladder leakage
- An urgent need to pee at night
- An inability to pee
BPH can also cause elevations of prostate-specific antigen (PSA), a protein produced by the prostate gland that increases in the presence of prostate cancer and other prostate problems.
Because a PSA test cannot distinguish BPH from prostate cancer, other tests may be ordered to help make the distinction. These include urine tests, a digital rectal exam (DRE), magnetic resonance imaging (MRI), and a prostate biopsy.
2. Prostatitis
Prostatitis is inflammation of the prostate gland. The inflammation may be due to a bacterial infection or occur in the absence of an infection (where it is referred to as chronic prostatitis/chronic pelvic pain syndrome, or CP/CPPS).
Prostatitis can cause many of the same urinary symptoms as prostate cancer, including frequent urination, pain with urination, and the need to urinate at night. It can also cause lower back pain and fever, symptoms commonly seen with advanced prostate cancer.
With that said, prostatitis differs in that symptoms often develop abruptly or can wax and wane over long periods. Pain in the perineum (situated between the anus and genitals) is also common with prostatitis and less so with prostate cancer.
Blood and urine tests can help confirm if bacteria are involved (including intestinal bacteria like Escherichia coli or sexually transmitted bacteria associated with gonorrhea or chlamydia).
During a DRE, the prostate will also be painful and boggy with prostatitis (as opposed to prostate cancer, where the gland may be hard, lumpy, and generally painless).
In the absence of an infection, CP/CPPS can be diagnosed by excluding all other causes, including prostate cancer.
3. Prostate Cysts
Prostatic cysts are fluid-filled sacs situated on or within the prostate gland. These benign growths are most often asymptomatic (without symptoms) and usually found by chance during imaging for other reasons.
Prostate cysts can look very similar to prostate cancer on initial imaging with an MRI or ultrasound. The cysts can also cause significant elevations in PSA levels, not unlike prostate cancer.
Upon closer inspection, prostate cysts tend to have a well-defined, smooth, oval shape. In contrast, prostate cancer tumors will often have an irregular shape with blurred edges as the cancer invades surrounding tissue.
If in doubt, healthcare providers may perform a needle biopsy, in which a needle is passed through the rectum or perineum into the prostate gland to obtain a tissue sample for evaluation in the lab.
4. Acute Cystitis
Acute cystitis is a type of urinary tract infection (UTI) involving the bladder. The condition, caused by a bacterial infection, can cause symptoms similar to advanced prostate cancer, including:
- The frequent, urgent need to pee
- Burning or stinging sensations during urination
- Pain or pressure in the lower abdomen or back
- Blood in the urine
- A general feeling of unwellness
Acute cystitis is one of several possible causes of bacterial prostatitis. However, it can sometimes bypass the prostate gland and leave PSA levels normal.
Acute cystitis can be differentiated with a urine culture (used to isolate and identify bacteria). If needed, a procedure called cystoscopy can visually inspect the bladder and obtain a tissue sample by passing a narrow, lighted scope into your urethra (pee hole).
A chronic, non-infectious form of cystitis, called interstitial cystitis, can also cause urinary symptoms but is far more common in women than in men.
5. Prostatic Atrophy
Prostatic atrophy refers to the shrinkage or deterioration of the prostate gland. It is a generally benign condition that can occur as part of normal aging. Still, it may also be the result of radiation or hormonal therapies used to treat prostate cancer.
Though prostatic atrophy is often asymptomatic, some people may experience urinary symptoms similar to prostate cancer, such as:
- Frequent or urgent urination
- Urination at night
- Difficulty starting a urine stream
- A feeling of incomplete bladder emptying
- Urinary incontinence and dribbling
Prostatic atrophy is considered one of the major imitators of prostate cancer. Even with diagnostic imaging and a biopsy, it can be challenging to differentiate between the two.
The microscopic evaluation of a tissue sample by a skilled pathologist may be needed to make the distinction, checking for differences in cell structure as well as the presence or absence of a normal nucleus.
6. Other Cancers
Other cancers of the genital and urinary tract can mimic the symptoms of prostate cancer or place stress on the prostate gland as the tumor grows larger. Some blood cancers can also target the urinary tract and trigger prostate cancer-like symptoms.
These include cancers like:
- Bladder cancer
- Kidney cancer
- Non-Hodgkin lymphoma
- Urethral cancer
Metastatic cancers are those that spread from an original (primary) tumor to distant sites. Among those that can spread to the urinary tract (including, on rare occasion, the prostate gland) are:
- Bladder cancer
- Breast cancer
- Colorectal cancer
- Melanoma
Talk to a Healthcare Provider
Because prostate cancer cannot be diagnosed by symptoms alone, it is important to see a healthcare provider if you have any signs that concern you. This includes elevated PSA levels, which may mean nothing but warrant further investigation if accompanied by symptoms like pain with urination or difficulty peeing.
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