What is Benign Prostatic Hyperplasia (BPH)?
Benign Prostatic Hyperplasia, commonly referred to as
BPH, is a non-cancerous enlargement of the prostate gland. This condition often affects older men and can lead to urinary symptoms due to the compression of the urethra.
Histological Features of BPH
In
histological terms, BPH is characterized by an increase in the number of epithelial and stromal cells in the prostate gland. This results in the formation of
nodules that can compress the urethral canal.
The prostate gland is composed of
glandular and stromal tissue. The hyperplastic process in BPH predominantly affects the periurethral zone. Histologically, the nodules formed can be seen as well-defined, rounded structures with a fibromuscular stroma and varying amounts of glandular elements.
Microscopic Examination
Under the microscope, the hyperplastic tissue in BPH shows increased numbers of both epithelial and stromal cells. The
glandular epithelium often appears crowded, and the glands may show infolding. The stromal component is typically composed of smooth muscle cells and fibroblasts.
The glands are lined by a double layer of cells: an inner columnar secretory layer and an outer flattened basal cell layer. In some cases, the lumina of these glands may contain
corpora amylacea, which are proteinaceous secretions that can calcify.
Pathophysiology of BPH
The exact cause of BPH is not fully understood, but it is believed to involve hormonal changes associated with aging. Increased levels of
dihydrotestosterone (DHT), a potent androgen, play a crucial role in the proliferation of prostatic cells.
Androgens stimulate the growth of both epithelial and stromal components of the prostate. Additionally, other factors such as
inflammatory cytokines and growth factors contribute to the hyperplastic process.
Clinical Implications
BPH can lead to urinary symptoms such as increased frequency, urgency, nocturia, and a weak urinary stream. These symptoms are collectively referred to as
Lower Urinary Tract Symptoms (LUTS). In severe cases, BPH can cause urinary retention and complications such as bladder stones or kidney damage.
Diagnosis
Diagnosis of BPH is often based on clinical symptoms, physical examination (including a digital rectal exam), and imaging studies. Histological examination of prostate tissue obtained through biopsy can confirm the diagnosis and rule out other conditions such as
prostatic adenocarcinoma.
Treatment
Treatment options for BPH include lifestyle modifications, medications, and surgical interventions. Medications such as
alpha-blockers and 5-alpha-reductase inhibitors are commonly used to relieve symptoms and reduce prostate size.
In cases where medications are ineffective, surgical options such as
Transurethral resection of the prostate (TURP) or laser therapy can be considered to remove the obstructive prostate tissue.
