In benign prostatic hyperplasia, or BPH, prostatic refers
to the prostate gland, hyperplasia means an
increase in the number of cells, and benign means
that these cells aren’t malignant, so they don’t
invade neighboring tissues.
So, benign prostatic hyperplasia is the non-
cancerous growth of the prostate gland.
This condition is common in men over 50, and
is often considered a normal part of aging.
The prostate is a small gland, about the size
and shape of a walnut, that sits under the bladder
and in front of the rectum.
The urethra which is the tube through which
urine leaves the bladder, goes through the prostate
before reaching the penis. And that part of the
urethra is called the
prostatic urethra.
The prostate is covered by a capsule of tough
connective tissue and smooth muscle.
Beneath this layer, the prostate can be divided
into a few zones:
The peripheral zone, which is the outermost
posterior section, is the largest of the zone
and contain about 70% of the prostate’s
glandular tissue.
Moving inward, the next section is the central
zone which contains about 25% of the glandular
tissue as well as the ejaculatory ducts that
join with the prostatic urethra.
Last, is the transitional zone, which contains
around 5% of the glandular tissue as well
as a portion of the prostatic urethra.
The transitional zone gets its name because
it contains transitional cells which are also
found in the bladder.
At the microscopic level, each of the tiny
glands that make up the prostate is surrounded
by a basement membrane made largely of
collagen.
Sitting within that basement membrane, is
a ring of cube-shaped basal cells as well
as a few neuroendocrine cells interspersed
throughout.
Finally, there’s an inner ring of luminal
columnar cells, which are within the lumen
or center of the gland.
Luminal cells secrete substances into the
prostatic fluid, that make it slightly alkaline
that give it nutrients which nourish the sperm
and help it survive in the acidic environment
of the vagina.
During an ejaculation, sperm leave the testes,
travel through the vas deferens, into the
ejaculatory ducts, and travel through the
prostatic urethra.
Smooth muscles in the prostate contract and push
the prostatic fluid into the urethra where it joins the
sperm as well as the semen which is the fluid that
comes from the seminal vesicles.
The luminal cells also produce prostate specific
antigen, or PSA, which helps to liquefy the gel-like
semen after ejaculation, thereby freeing the sperm
to swim.
The basal cells and luminal cells of the prostate
rely on stimulation from androgens, or male sex
hormones, for survival.
The androgens include testosterone, which
is produced by the testicles, and
dihydrotestosterone, which is produced in the
prostate itself.
This androgen is produced by the prostatic
enzyme 5α-reductase which converts testosterone
into the more potent dihydrotestosterone.
Since androgens are steroids, so they can
cross the cell membrane and bind to the androgen
receptors within the cell’s nucleus. This inhibits
apoptosis or programmed cell
death, allowing luminal and basal cells in the
prostate to keep growing and multiplying.
Dihydrotestosterone is ten times more potent
than testosterone because it can bind to androgen
receptors much longer.
Now, after the age of 30, men produce about
1% less testosterone per year.
But for unclear reasons, 5α-reductase activity
increases with age, so even with less testosterone,
there could be an increase in dihydrotestosterone.
Normal prostate cells respond to the increase
in dihydrotestosterone levels by living longer and
multiplying - that’s the underlying cause of benign
prostatic hypertrophy.
This is a normal process of aging, and around
50% of men develop BPH by the age of 60, and
over 90% have it by the age of 85.
Fortunately, in BPH there’s no increased
risk for developing cell mutations that lead to
prostate cancer.
Rather, the entire prostate gland enlarges
pretty uniformly and small hyperplastic nodules can
form within it.
These nodules are smooth, elastic, and firm
and are sometimes mistaken for prostate cancer.
Typically, hyperplastic nodules will form
in the inner portions of the gland, specifically
around the prostatic urethra, called the periurethral
zone.
When these nodules or the prostate tissue
itself compresses the prostatic urethra, it becomes
more difficult for urine to pass though.
So the urine builds up in the bladder causing
it to dilate.
In response, the smooth muscle walls of the
bladder will contract harder, and this leads
to bladder hypertrophy were the walls thicken
and become easily irritated.
Finally, the stagnation of urine in the bladder
also promotes bacterial growth, and can lead
to urinary tract infections.
Symptoms of BPH include urinary problems like
urinary hesitancy, dysuria, dribbling, feeling of
bladder fullness, and nocturia.
BPH treatments include medications like 5α-
reductase inhibitors, α1-antagonists, or a TURP
procedure.

Symptoms of BPH start up when the prostatic

urethra gets obstructed, and it leads to a weak and
inconsistent stream of urine, called dribbling.

The person might also have to strain when

urinating to overcome the obstruction, have
pain during urination called dysuria, or trouble
initiating urination called hesitancy.

As urine builds up in the bladder it causes

a constant sense of incomplete bladder emptying,
which increases the frequency of urination
at night - called nocturia.

Benign prostatic hyperplasia can be identified

with a digital rectal examination, which is
where a finger is inserted into the rectum
to feel against the anterior wall of the rectum
which lies along the posterior prostate.

An enlarged prostate could indicate benign

prostatic hyperplasia, while hard nodules
could be a sign of prostate cancer.

Levels of prostate specific antigen or PSA,

a substance produced by healthy prostate cells,
are also elevated in benign prostatic hyperplasia,
since there are more cells around making the PSA.

Treatment of BPH focuses on relieving the

obstruction and allowing the urine to flow normally.

This can be done through medications like

finasteride, a 5α-reductase inhibitor, which
shrinks the prostate gland by inhibiting the
conversion of testosterone into
dihydrotestosterone.

Next, α1-antagonists like phenoxybenzamine

can bind to α1 receptors on the smooth muscles
in the neck of the bladder, the prostate, and
urethra, causing them to relax and allowing urine to
pass.

In some cases, surgical procedures like

transurethral resection of the prostate, or
TURP, can be done to remove part or all of the
prostate.

Benign prostatic hyperplasia, of BPH is a condition

caused by increased 5α-reductase activity in the
prostate which leads to increased
dihydrotestosterone production, and prostate
hyperplasia.

This is considered to be a normal part of

aging and does not increase the risk of developing
prostate cancer.

The enlarged prostate gland can obstruct the

prostatic urethra, which will lead to urine retention,
causing the bladder to dilate and
hypertrophy.