Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a histological diagnosis characterised by a non-malignant proliferative process of the prostatic stromal cells.

• is considered as the commonest benign neoplasm in males
• commonly seen in older men and may even be regarded as a natural part of ageing.
• it is unusual before 50 years of age.

The transition zone of the prostate is affected by BPH, which results in compression of the prostatic urethra and restriction of flow out of the bladder.

Benign prostatic obstruction (BPO) is a main aetiology for ageing men to experience LUTS, and it differs from benign prostatic hyperplasia (BPH) and benign prostatic enlargement (BPE)

BPE refers to an increase in volume of the prostate due to BPH. BPO is an obstruction that results from BPE, which can be confirmed by pressure flow studies or be highly suspected from flow rates and if the gland is enlarged.

Many patients are asymptomatic or have mild disease. Only 20% of those over 60 years have disease sufficiently severe to warrant surgery.

The cause of the hyperplasia is uncertain. Hormonal and neoplastic explanations have been proposed. The condition is not thought to be premalignant.

References:

1. European Association of Urology. Management of non-neurogenic male LUTS. 2024 [internet publication].
2. Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023. J Urol. 2024 Jan;211(1):11-9.