Epidemiology of Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) is one of the most common diseases of aging men, with prevalence increasing dramatically with age from initial development after age 40, reaching greater than 50% by age 60, and as high as 90% by age 85. 1, 2
Age-Related Prevalence
- BPH shows a strong age-dependent pattern, with histopathologic evidence beginning to appear after age 40 1
- By age 60, prevalence exceeds 50% of men 1
- By age 80, prevalence reaches approximately 80% 2
- By age 85, prevalence is as high as 90% 1
Symptom Prevalence
- Approximately half of all men with histologic BPH develop moderate to severe lower urinary tract symptoms (LUTS) 1
- The prevalence of bothersome symptoms increases with age, similar to histologic evidence 1
- By age 80, nearly 50% of men experience moderate-to-severe LUTS 2
- The impact of LUTS on quality of life is highly variable and not directly related to measurable physiological factors 1
Pathophysiological Mechanisms
- BPH develops due to an imbalance between cellular growth and apoptosis favoring growth in the prostatic transition zone 2
- BPH can lead to benign prostatic enlargement (BPE), which may cause obstruction at the bladder neck (benign prostatic obstruction or BPO) 2
- BPH contributes to LUTS through two primary mechanisms:
Risk Factors
- Age is the most significant non-modifiable risk factor 2
- Hormonal factors, particularly the conversion of testosterone to dihydrotestosterone (DHT), play a crucial role in BPH development 2
- Functioning testicles since puberty are necessary for BPH development 4
Clinical Significance
- BPH-associated mortality is rare in the United States 1
- Serious complications are uncommon, though the risk of acute urinary retention increases with age 1, 2
- Approximately 30% of men may ultimately require surgery for BPH 5, 4
- BPH is the cause of the most common surgical procedure in elderly men 5
Global Impact
- BPH has substantial and increasing influence on morbidity, quality of life, and healthcare costs due to the aging population 5
- In many developed countries, male life expectancy is approaching 80 years, meaning half of all men born can expect to reach an age where they have an 88% chance of developing histological BPH 5
Clinical Presentation
- LUTS are bothersome to many patients, with the degree of bother varying greatly among individuals with the same symptom severity 1
- The patient's perception of symptom severity and interference with lifestyle should be the primary consideration in choosing therapy 1
- Men tend to discuss urination problems with doctors not when symptoms develop but when they become bothersome 5
BPH represents a significant health concern for aging men, with nearly universal prevalence in the oldest age groups. While rarely fatal, it substantially impacts quality of life and healthcare utilization worldwide.