INTRODUCTION

Benign prostatic hyperplasia—also called BPH—is a condition in men in which the prostate gland is
enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or
benign prostatic obstruction.

The prostate goes through two main growth periods as a man ages. The first occurs early in puberty,
when the prostate doubles in size. The second phase of growth begins around age 25 and continues
during most of a man’s life. Benign prostatic hyperplasia often occurs with the second growth phase.

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes
thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine
in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder
completely—cause many of the problems associated with benign prostatic hyperplasia.

The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men.
Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For
this reason, some researchers believe factors related to aging and the testicles may cause benign
prostatic hyperplasia.

Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a
female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a
higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may
occur because the higher proportion of estrogen within the prostate increases the activity of substances
that promote prostate cell growth.

Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate
development and growth. Some research has indicated that even with a drop in blood testosterone
levels, older men continue to produce and accumulate high levels of DHT in the prostate. This
accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men
who do not produce DHT do not develop benign prostatic hyperplasia.

Benign prostatic hyperplasia is the most common prostate problem for men older than age 50. In 2010,
as many as 14 million men in the United States had lower urinary tract symptoms suggestive of benign
prostatic hyperplasia.1 Although benign prostatic hyperplasia rarely causes symptoms before age 40, the
occurrence and symptoms increase with age. Benign prostatic hyperplasia affects about 50 percent of
men between the ages of 51 and 60 and up to 90 percent of men older than 80.

A common, noncancerous enlargement of the prostate gland. The enlarged prostate may compress the
urinary tube (urethra), which courses through the center of the prostate, impeding the flow of urine
from the bladder through the urethra to the outside. Abbreviated BPH. If BPH is severe enough,
complete blockage can occur. BPH generally begins after age 30, evolves slowly, and causes symptoms
only after age 50. Half of men over age 50 develop symptoms of BPH, but only a minority need medical
or surgical intervention. Medical therapy includes drugs such as finasteride and terazosin. Prostate
surgery has traditionally been seen as offering the most benefits'and the most risks'for BPH. BPH is not a
sign of prostate cancer. Also known as benign prostatic hypertrophy and nodular hyperplasia of the
prostate.

The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out
of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins
to block urine flow.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges
the prostate enough to cause urinary symptoms or to significantly block urine flow.

It isn't entirely clear what causes the prostate to enlarge. However, it might be due to changes in the
balance of sex hormones as men grow older.

Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40. About one-
third of men experience moderate to severe symptoms by age 60, and about half do so by age 80.
Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of
BPH.

Clinical benign prostatic hyperplasia (BPH) is one of the most common diseases in ageing men and the
most common cause of lower urinary tract symptoms (LUTS). The prevalence of BPH increases after the
age of 40 years, with a prevalence of 8%–60% at age 90 years. Some data have suggested that there is
decreased risk among the Asians compared to the western white population.

The prevalence of BPH rises markedly with increased age. Autopsy studies have observed a histological
prevalence of 8%, 50%, and 80% in the 4th, 6th, and 9th decades of life, respectively [1]. Observational
studies from Europe, US, and Asia have also demonstrated older age to be a risk factor for clinical BPH
onset and progression [2], [3], [4]. Furthermore the prostate volume increases with age based on data
from the Krimpen and Baltimore Longitudinal Study of Aging suggesting a prostate growth rate of 2.0%–
2.5% per year in older men [5], [6]. Continued prostate growth is a risk factor for LUTS progression and
larger prostates are associated with benign prostatic enlargement (BPE) and increased risks of clinical
BPH progression, urinary retention and need for prostate surgery

Diabetes and disruptions in glucose homeostasis

Physician-diagnosed diabetes, increased serum insulin and elevated fasting plasma glucose have been
associated with increased prostate size and increased risk of prostate enlargement, clinical BPH and BPH
surgery

With a changing demographic profile and an increasingly ageing population in almost all societies, it is
inevitable that this disorder will become even more prevalent and a major challenge for all health care
systems in the future. Apart from medications, one important strategy is advice on exercise and diet,
encouraging the patient to self-manage his disease. This may help to reduce the need for surgery with its
many possible side effects and long term recurrence.

Lowering elevated blood pressure reduces mortality and the risk of stroke, coronary heart disease and
heart failure.

The presence of benign prostatic hyperplasia (BPH) is a compelling indication for the use of an alpha
blocker in the treatment of hypertension. Alpha blockers are first-line therapy for men with lower urinary
tract symptoms (LUTS) and prostatic hyperplasia. In men with prostates larger than 30 cm3 or prostate-
specific antigen > 1.4 ng/ml, 5-alpha reductase inhibitors may also be added. Typically, alpha blockers
improve LUTS by 30–40% and maximum urinary flow rates by 16–25%, with clinical improvement within
two weeks. The 5-alpha antagonists are only effective in men with a large prostate and may take up to six
months to achieve their full effect.

The Medical Treatment of Prostatic Symptoms (MTOPS) study assessed the long-term effects of
doxazosin, finasteride and combination treatment on symptom scores, the clinical progression of BPH
and the long-term risk of complications. Combination treatment reduced the risk of clinical progression
by 66%, a significantly greater reduction than that induced by either agent alone. The improvement in
the symptom score was also significantly greater in the combination treatment group.

Erectile dysfunction (ED) may be a marker for other diseases, such as hypertension. ED is both more
prevalent and more severe among patients with hypertension than among the general population. The
link may be related to nitric oxide/cyclic GMP pathways and endothelial function. Many prescription
drugs are associated with ED, including antihypertensive agents. The alpha blockers and angiotensin
receptor blockers are the drugs least likely to cause ED, and may even improve the situation. All currently
licensed ED treatments are suitable for managing ED in the cardiovascular patient, when used according
to the manufacturer’s instructions. PDE5 inhibitors and alpha blockers should be temporally separated,
or selective alpha blockers may be preferable, in order to avoid postural hypotension.

Deters LA. Benign prostatic hypertrophy. Emedicine website. http://emedicine.medscape.com . Updated

March 28, 2014. Accessed July 29, 2014.

[2] BPH: surgical management. Urology Care Foundation website. www.urologyhealth.org . Updated July
2013. Accessed July 29, 2014.

[3] Enlarged prostate. MedlinePlus website. www.nlm.nih.gov . Updated October 2, 2013. Accessed July
29, 2014.

September 2014