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Benign Prostatic Hyperplasia

Abstract
• Benign Prostate Hyperplasia > 50 years old
• Leading to :
– Urgency
– Frequency Due to activation of
metabolite 5 - Dyhydroxy
– Incomplete voiding Testosterone (5-DHT)

– Residual urine
– UTI, even to cancer state
Abstract
• Risk Factor : • Treatment
– Increasing age – Alpha adrenegic
– Genetic factors – Anti DHT drugs
– Obesity – TURP
– Excess testosterone
– Inflamation
– Trace elements zinc
– Vit CD
Introduction
• BPH  common disease of aging male

Microscopic
Symptoms

Macroscopic

Symptomatic

Asymptomatic
Genetic Hormonal Susceptibility of
BPH
INTRACELLULAR STEROID SIGNALLING PATHWAY Increase BPH risk

Androgen
Binds
Androgen Receptors Important for the normal growth
Activated
Prostate Specific
Antigen (PSA)
Involved in
PROSTATE
Cell-cycle control GROWTH
Genetic Hormonal Susceptibility of
BPH
• Other Genes that Associated with Prostate
Growth  Prostate Cancer
– Steroid 5 – reductase type II
– TGF – β1
– Glu-298-Asp
– VDR gene
– α1 – adrenergic receptors, also contributes to
LUTS
Inflammatory cytokines, molecular
studies in BPH
• Inflammatory injury  cytokines production
 increase growth factor production and
angiogenesis of prostate (Stromal hyper
proliferation and tissue remodelling because
of hypoxia) with prove from recent studies
that BPH is an immune inflammatory disease.
• T-cell seemed to induced epitelial and stromal
growth
Inflammatory cytokines, molecular
studies in BPH
• Cytokine IL-17 A, E.F with their receptor IL-
17RA, IL-17BR, IL-17 CR, IL-17E and IL-17F
significantly found elevated in prostatic tissue
in BPH with increased of inflammatory cells
and CD 31(+)
• Differential IHC expression of CD44s, E-
Cadherin and β-catenin among hyerplastic and
homoplastic lesions of prostate gland
Inflammatory cytokines, molecular
studies in BPH
• 26 cases of PCa and 38 cases of BPH were
sampled, immune reactivity showed :
– Aurora kinase 15,4, 53,8 and 30,7% in PCa
– Aurora kinase73,3, 73,7 and 84,2% in BPH
• Acnotamin 1 (ANO1) ---- Ca (2+) ---- CaCC
---- mediated various physiological
Encode

functions.
Showed

• Testosterone induced BPH


Inflammatory cytokines, molecular
studies in BPH
• COX 2 and INOS also contribute to prostate
growth, showed by :
– ROS  repeated tissue damage and post-
translation DNA modifications  induced
neoplasma in prostate
Metabolic Syndrome (Diabetes, insulin
resistance) and BPH

BPH
(hiperinsulinemia 
IGF  Prostate growth
Diabetes
LUTS (because of
obesity, insulin resistance
and androgen deficiency)
Obesity, physical activity and lifestyle
changes and BPH

Physical BPH
Obesity Diet INFLUENCED
activity LUTS

5α-
reductase
inhibitor
Vitamin D and BPH

Increasing Vitamin D
Effect
Up to 6000 IU/days
Result
- Decrease BPH cell
- Decrease prostate Decrease incident
cell proliferation of BPH
Serum Zinc and BPH
• Serum zinc level was increasing in benign,
premalignant and malignant lesion of
prostate.
• In BPH