Benign prostatic hyperplasia – what do we know?

Abstract

Objectives To present historical and contemporary hypotheses on the pathogenesis of benign prostatic hyperplasia (BPH), and the potential implications for current medical therapies. Methods The literature on BPH was reviewed. BPH is a prevalent disease with significant health and economic impacts on patients and health organisations across the world, whilst the cause/initiation of the disease process has still not been fully determined. Results In BPH, pathways involving androgens, oestrogens, insulin, inflammation, proliferative reawakening, stem cells and telomerase have been hypothesised in the pathogenesis of the disease. A number of pathways first described >40 years ago have been first rebuked and then have come back into favour. A system of an inflammatory process within the prostate, which leads to growth factor production, stem cell activation, and cellular proliferation encompassing a number of pathways, is currently in vogue. This review also highlights the physiology of the prostate cell subpopulations and how this may account for the delay/failure in treatment response for certain medical therapies. Conclusion BPH is an important disease, and as the pathogenesis is not fully understood it impacts the effectiveness of medical therapies. This impacts patients, with further research potentially highlighting novel therapeutic avenues.

Piceatannol Attenuates Testosterone-Induced Benign Prostatic Hyperplasia in Rats by Modulation of Nrf2/HO-1/NFκB Axis

“…It was observed that prostatic hyperplasia was accompanied and/or preceded by a background of inflammatory status. Studies on the pathophysiology of BPH highlighted a significant role for inflammation and inflammatory mediators ( McClinton et al, 1990 ; Theyer et al, 1992 ; Madersbacher et al, 2019 ; Devlin et al, 2020 ). In particular, inflammation was reported to be a key-player in testosterone-induced BPH ( Rastrelli et al, 2019 ).…”

“…Elevation in serum testosterone and insulin have been suggested to participate in BPH induced by metabolic syndrome ( Muller et al, 2005 ). BPH includes an abnormally enlarged prostate gland that causes problematic symptoms, including: decreased urinary flow and frequency, trouble initiating flow, nocturia and dribbling ( Berry et al, 1984 ; Devlin et al, 2020 ). Unfortunately, the histological prevalence of BPH at autopsy is believed to be as high as 50%–60% for men in their 60’s, and up to 80%–90% of those over 70 years of age ( Ng and Baradhi, 2020 ).…”

Global, Regional, and National Incidence and Year Lived with Disability for Benign Prostatic Hyperplasia from 1990 to 2019

“…In 2006, a cross-sectional survey in six European countries revealed that the mean one-year treatment costs were €858 per patient, three quarters of which concerned medication costs (van Exel et al, 2006). In 2006, UK spent £44 million on primary care, £69 million on drug treatment, and £101 million for treating BPH associated complications, such as AUR (Devlin et al, 2020). In 2019, an estimate based on a cost and treatment pattern reflective of USA Medicare costs reported that the global medical service costs of BPH reached $73.8 billion annually (Launer et al, 2020).…”

The Etiology and Pathophysiology Genesis of Benign Prostatic Hyperplasia and Prostate Cancer: A New Perspective

“…The etiology and pathophysiology genesis mechanisms of benign prostatic hyperplasia and prostate cancer have not yet been fully elucidated [1][2][3][4][5]. Men's age is clearly the strongest risk factor [6][7][8][9].…”