From the Guidelines
Benign Prostatic Hyperplasia (BPH) is a histologic diagnosis describing the proliferation of smooth muscle and epithelial cells within the prostatic transition zone, leading to lower urinary tract symptoms (LUTS) in aging men.
Definition and Pathophysiology
- BPH is a multifactorial process that requires testosterone and involves the conversion of testosterone to dihydrotestosterone (DHT) by 5-alpha-reductase, leading to an imbalance between growth and apoptosis in favor of growth, and subsequent increase in cellular mass 1.
- The condition is nearly ubiquitous in aging males, with increases starting at age 40-45 years, reaching 60% by age 60, and 80% by age 80 1.
Clinical Presentation
- BPH can lead to benign prostatic enlargement (BPE), which can cause obstruction at the level of the bladder neck, termed benign prostatic obstruction (BPO), resulting in LUTS such as storage and voiding/emptying symptoms 1.
- Male LUTS may be caused by a variety of conditions, including BPE and BPO, and can be progressive, as seen in the Olmsted County Study 1.
Diagnosis and Treatment
- The diagnosis of BPH is based on a combination of clinical evaluation, medical history, and diagnostic tests, and treatment options include medical management with 5-alpha-reductase inhibitors such as finasteride and dutasteride, as well as surgical management for severe cases 1.
- Finasteride has been shown to be effective in partially relieving symptoms, reducing the risk of subsequent acute urinary retention, and the need for BPH-related surgery, with a comparable safety profile to dutasteride 1.
From the Research
Definition and Pathophysiology of Benign Prostatic Hyperplasia (BPH)
- Benign prostatic hyperplasia (BPH) is a nonmalignant adenomatous overgrowth of the periurethral prostate gland commonly seen in aging men 2.
- BPH is characterized by the proliferation of prostatic epithelial and stromal cells, leading to bladder outlet obstruction and the exacerbation of lower urinary tract symptoms 3.
- The pathophysiology of BPH is multifaceted, involving factors such as hormonal changes, hypoxia, urine reflux into prostatic ducts and stroma, autoimmune responses, and infection-induced inflammation 3, 4.
Symptoms of BPH
- Symptoms of BPH include urinary hesitancy, incomplete bladder emptying, dribbling or prolonged urination, nocturia, urinary urgency, and/or urge incontinence 2, 5, 6.
- BPH can cause both obstructive and irritative symptoms, as well as symptoms that affect the patient after micturition, such as postvoid dribble or incomplete emptying 6.
Diagnosis and Treatment of BPH
- Understanding the differential diagnosis and ordering appropriate laboratory tests are essential in accurately identifying a BPH diagnosis 2.
- Treatment options for BPH include medical or pharmacological therapies, such as α1-blockers, 5α-reductase inhibitors, and phosphodiesterase 5 inhibitors, as well as surgical therapies 2, 3, 4, 5.
- The choice of treatment depends on the severity of symptoms and the degree of bother, with watchful waiting being a common starting point for patients with mild symptoms 6.