Introduction
The histopathological diagnosis of benign prostatic hyperplasia is characterized by epithelial cell and smooth muscle cell proliferation in the transition zone of the prostate leading to a non-malignant enlargement of the gland, which may result in lower urinary tract symptoms (LUTS), including voiding and storage symptoms.
Epidemiology
Benign prostatic hyperplasia is a common disease of aging men; this can be asymptomatic. It has been noted that the prevalence of histologically diagnosed benign prostatic hyperplasia increases from 8 percent in patients 31-40 years old, to 40-50% between ages 51-60, to over 80% in patients older than 80 years old. In the United States (US), it has been estimated that as much as 70% of men between ages 60-69 years, and nearly 80% of men ≥70 years, have benign prostatic hyperplasia. It is expected that as the worldwide population grows older, the number of symptomatic benign prostatic hyperplasia cases rise; globally, there has been a marked rise in the prevalence and incidence of benign prostatic hyperplasia.
Local studies in Malaysia show that Malaysian men are equally affected by benign prostatic hyperplasia as their western counterpart; about 50% of men above 50 years of age are affected by symptomatic benign prostatic hyperplasia.
Pathophysiology
It must be noted that the two phases where prostate doubles its size are puberty and 25 years old and above.
The development of benign prostatic hyperplasia and LUTS is likely to be multifactorial. LUTS occur as a result of prostatic obstruction and an increase in smooth muscle tone and resistance. Benign prostatic enlargement together with the resulting prostatic obstruction affects detrusor activity, thus leading to detrusor instability or overactive bladder (OAB). This, in addition to age-related changes to the detrusor muscle, compounds benign prostatic hyperplasia-associated LUTS.
Etiology
The exact cause of benign prostatic hyperplasia is not well understood but may be due to male androgenic steroid hormones or age-related increases in sympathetic tone.
Risk Factors
Risk factors for benign prostatic hyperplasia include:
- Age ≥40 years old
- Family history of benign prostatic hyperplasia
- Medical conditions such as obesity, heart and circulatory disease, type 2 diabetes mellitus (DM)
- Lack of physical exercise