Symptoms, Causes and Pathophysiology of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is an increase in size of the prostate. Also called benign enlargement of the prostate (BEP), adenofibromyomatous hyperplasia and benign prostatic hypertrophy.

Prostate enlargement is very common as men age -- symptoms usually develop around age 50 and by age 60, most men have some degree of BPH. At age 85, men have a 90% chance of having urination problems caused by BPH. It' s important to note that BPH is not cancer, and it does not put you at increased risk for developing prostate cancer.

Causes of Benign Prostatic Hyperplasia :

Nobody knows the basic cause of BPH. Research shows that testosterone, the male hormone, or dihydrotestosterone, a chemical produced when testosterone breaks down in a man's body, may cause the prostate to keep growing. Another theory is that changes in the ratio of testosterone and estrogen (female hormone) as men age cause the prostate to grow.

Some over the counter medications for colds or allergies can drastically worsen BPH.

Symptoms of Benign Prostatic Hyperplasia :
  • Needing to urinate frequently
  • Difficulty starting urination
  • Stopping and starting while urinating
  • Urinating frequently at night (nocturia)
  • Dribbling after urination ends
  • Being unable to empty your bladder
  • Blood in the urine (BPH can cause small blood vessels to burst)
  • Recurrent urinary tract infections (UTIs)

Pathophysiology of BPH

Both the glandular epithelial cells and the stromal cells (including muscular fibers) undergo hyperplasia in BPH. Most sources agree that of the two tissues, stromal hyperplasia predominates, but the exact ratio of the two is unclear.

Anatomically, BPH is most strongly associated with the posterior urethral glands (PUG) and transitional zone (TZ) of the prostate. The earliest microscopic signs of BPH usually begin between the age of 30 and 50 years old in the PUG, which are posterior to the proximal urethra. However, the majority of growth eventually occurs in the TZ. In addition to these two classic areas, the peripheral zone (PZ) of the prostate is also involved to a lesser extent. Since prostatic cancer also occurs in the PZ, BPH nodules in the PZ are often biopsied to rule out cancer.

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