Benign prostatic hyperplasia refers to the increase in size of the prostate in middle-aged and elderly men.It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes the normal flow of urine. It leads to symptoms of urinary hesitancy, frequent urination, dysuria, increased risk of urinary tract infections, and urinary retention.BPH is not considered to be a premalignant lesion.
Adenomatous prostatic growth is believed to begin at approximately age 30 years. An estimated 50% of men have histologic evidence of BPH by age 50 years and 75% by age 80 years. In 40-50% of these patients, BPH becomes clinically significant
Androgens (testosterone and related hormones) are considered to play a permissive role in BPH by most experts. Dihydrotestosterone (DHT), a metabolite of testosterone, is a critical mediator of prostatic growth. DHT is synthesized in the prostate from circulating testosterone by the action of the enzyme 5α-reductase, type 2.
Rectal examination and transrectal ultrasonography. may reveal a markedly enlarged prostate, usually affecting the middle lobe.Often, blood tests(prostate specific antigen) levels are performed to rule out prostatic cancer.
The two main medications for management of BPH are alpha blockers and 5α-reductase inhibitors.