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Can an enlarged prostate lead to death?

In the case of BPH, the prostate can eventually become large enough that it partially or completely blocks the urethra, leading to inability to urinate, urinary tract infections, bladder and kidney damage, and if left completely untreated, ultimately to death.

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Francis P. Boscoe, Ph.D, Research Scientist, New York State Cancer Registry (NAACCR at-large Board Member) Why are so many men in California dying of hyperplasia of the prostate? Many people have been asking this question lately in response to an article I wrote identifying the most distinctive causes of death in every state, which has been receiving a lot of media coverage and circulation in the blogosphere. Hyperplasia of the prostate is ICD-10 code N40, and goes by the synonyms of enlarged prostate, nodular prostate, polyp of prostate, benign prostatic hypertrophy, adenofibromatous hypertrophy of prostate, and, most familiarly, BPH. It does not include either benign or malignant prostate neoplasms, which have ICD-10 codes D29.1 and C61, respectively.

There were 937 deaths due to BPH in California in the period 2001-2010, for an age-adjusted rate of 8 per million men, compared with 4 per million nationally. The real question is perhaps not why California is double the national average, but why even the national average is as high as it is. Should anyone at all be dying from a condition that includes the word “benign”?

It turns out that BPH behaves like benign brain tumors that are familiar to many readers of this blog: the condition itself is benign, but can become lethal once the growth reaches a point that it begins to impede the function of nearby tissues or organs. In the case of BPH, the prostate can eventually become large enough that it partially or completely blocks the urethra, leading to inability to urinate, urinary tract infections, bladder and kidney damage, and if left completely untreated, ultimately to death. Given that BPH is a treatable condition, one could reasonably argue that a death rate of 8 per million or even 1 per million is unacceptably high. While it is true that death rates have dropped dramatically since the 1970s – by 95% according to one English study – they have leveled off in recent years (in California, the age-adjusted mortality rate has varied between 6 and 9 per million men each year from 1999 to 2013). Also, given the number of people I’ve spoken with over the past week who thought that the appearance of BPH on the map must represent some kind of error – even some who are medically knowledgeable – I think calling attention to this rare but preventable cause of death has been useful.

The NIH has a helpful fact sheet on BPH here.

Abstract

The most distinctive cause of death (defined as the location quotient) for each state and the District of Columbia, 2001–2010. The map shows the cause of death from the International Classification of Diseases, 10th Revision (ICD-10), List of 113 Selected Causes of Death with the highest age-adjusted mortality rate ratio in each state. The causes are listed in the legend in the order of disease classification in ICD-10. This map highlights nonstandard cause-of-death certification practices within and between states that can potentially be addressed through education and training.

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How accurate are prostate blood tests?

How accurate is the PSA test? About 3 in 4 men with a raised PSA level will not have cancer and around 1 in 7 men with a normal PSA level will have prostate cancer.

The PSA test is a blood test to help detect prostate cancer. But it's not perfect and will not find all prostate cancers. The test, which can be done at a GP surgery, measures the level of prostate-specific antigen (PSA) in your blood. PSA is a protein made only by the prostate gland. Some of it leaks into your blood, but how much depends on your age and the health of your prostate. There's currently no national screening programme for prostate cancer in the UK because the PSA test is not always accurate. Before deciding to have the PSA test, you may want to talk to a GP and practice nurse, as well as your partner or a friend or family member.

You have a higher risk of prostate cancer if you:

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