Benign Prostatic Hyperplasia and Its Aetiologies

Context: Benign prostatic hyperplasia (BPH) is a well-known condition characterised by prostate growth accompanied by lower urinary tract symptoms. Several mechanisms seem to be involved in the development and progression of BPH. Objective: To review the most important findings regarding the key mechanisms involved in the pathophysiology of BPH. Evidence acquisition: During the 2009 annual meeting of the European Association of Urology in Stockholm, Sweden, a satellite symposium was held on BPH and its treatment. This paper is based on one of the presentations at the symposium. A structured, comprehensive literature review was performed using data retrieved from recent review articles, original articles, and abstracts. Evidence synthesis: Several mechanisms seem to be implicated in the pathophysiology of BPH. These represent age-related tissue modifications, hormonal alterations, and metabolic syndrome as well as inflammation. Although androgens do not cause BPH, the development of BPH requires the presence of androgens. Moreover, several studies support the association between noninsulin-dependent diabetes mellitus, hypertension, obesity, and low high-density lipoprotein cholesterol and the development of BPH. Finally, recent increasing evidence seems to support the idea that BPH consists of an inflammatory-based disorder. Inflammation would be initiated by an unknown stimulus that would create a proinflammatory milieu within the gland. This theory is confirmed by several basic research and clinical studies that showed a statistically significant association between inflammation and BPH severity and progression. Conclusions: Although the pathogenesis of BPH is not yet fully understood, several mechanisms seem to be involved in the development and progression of the disease. These mainly include systemic and local hormonal and vascular alterations as well as prostatic inflammation that would stimulate cellular proliferation. Inflammation would be initiated by an unknown stimulus that would create a proinflammatory environment within the prostate. Therefore, from the recent clinical and basic research studies, a novel approach in the clinical management of BPH might focus on the inflammatory process involved in the development and progression of the disease.