What is the condition of an enlarged prostate called?

Benign Prostatic Hyperplasia (BPH)

The condition of an enlarged prostate is called benign prostatic hyperplasia (BPH). 1

Definition and Pathophysiology

• BPH is a histologic diagnosis that refers to the proliferation of glandular epithelial tissue, smooth muscle, and connective tissue within the prostatic transition zone. 1
• BPH develops due to an imbalance between growth and apoptosis (cellular death) in favor of growth, subsequently causing an increase in cellular mass. 1
• The condition requires testosterone, which is converted to dihydrotestosterone (DHT) by 5α-reductase enzymes. DHT has a higher affinity for the androgen receptor and is considered the more potent androgenic steroid hormone. 1

Prevalence and Epidemiology

• BPH is nearly ubiquitous in the aging male, with prevalence increasing starting at age 40-45 years, reaching 60% by age 60, and 80% by age 80. 2
• The prevalence of moderate-to-severe lower urinary tract symptoms (LUTS) rises to nearly 50% by age 80. 1
• Approximately 90% of men between 45 and 80 years of age suffer some type of LUTS related to BPH. 2

Clinical Manifestations

• BPH contributes to LUTS via two primary mechanisms: 2

  • Static component: Direct bladder outlet obstruction (BOO) from enlarged tissue
  • Dynamic component: Increased smooth muscle tone and resistance within the enlarged gland

• Common symptoms include: 3

  • Storage symptoms: Urgency, frequency, nocturia
  • Voiding symptoms: Weak stream, hesitancy, intermittency, straining, and sensation of incomplete emptying

Complications

• Acute urinary retention (AUR) is a significant complication, with risk increasing with age (from 6.8 episodes per 1,000 patient years in the overall population to 34.7 episodes in men aged 70 and older). 2
• Other potential complications include bladder stones and, rarely, renal insufficiency in advanced cases. 3

Diagnostic Approach

• Initial evaluation should include medical history, physical examination (including digital rectal examination), International Prostate Symptom Score (IPSS), and urinalysis. 2
• Symptom severity is classified as: 3
  • Mild symptoms: IPSS score 0-7
  • Moderate symptoms: IPSS score 8-19
  • Severe symptoms: IPSS score 20-35

Treatment Options

• Alpha-adrenergic antagonists (alpha blockers) are first-line therapy for most men with moderate symptoms. 2, 4
• 5-alpha reductase inhibitors (5ARIs) are effective for men with larger prostates (>30cc). 2
• Transurethral resection of the prostate (TURP) remains the gold standard surgical approach for men with more severe symptoms or those who fail medical therapy. 1

Important Clinical Considerations

• BPH is rarely life-threatening, but its impact on quality of life can be significant. 2
• A common pitfall is failing to assess post-void residual urine, which can miss important information about bladder function. 3
• Patients should be evaluated 4-12 weeks after initiating treatment to assess response. 2