Prostatic hyperplasia and prostate cancer are sometimes very difficult to distinguish clinically, as both diseases occur in elderly men, can cause lower urinary tract symptoms, and lead to elevated PSA levels. However, prostatic hyperplasia generally has a longer medical history, whereas prostate cancer has a shorter history and progresses more quickly. During a digital rectal exam for prostatic hyperplasia, the gland appears enlarged and the surface is smooth. In contrast, during a prostate exam, the gland may show irregular enlargement, a rough surface, and the tumor feels firm. When these two are difficult to distinguish, considering a prostate biopsy may be advisable.