Definition

• BPH is a nonmalignant enlargement of the prostate

gland caused by cellular hyperplasia of both
glandular and stromal elements that leads to
troublesome lower urinary tract symptoms (LUTS) in
some men

• It is the most common benign tumor in men and is

not a precancerous condition
 Anatomy and physiology

• The prostate is a compound tubuloalveolar

exocrine gland of the male mammalian
reproductive system

• Function is to store and secrete a clear,

slightly alkaline fluid that constitutes 10-30%
of the volume of the seminal fluid that along
with the spermatozoa, constitutes semen

• Secret is composed of simple sugars and

proteins (proteolytic enzymes, acid
phosphatase, prostate-specific antigen);zinc
and citric acid
Lower urinary tract
 Anatomy and physiology

• A healthy human prostate is slightly larger

than a walnut (4cm by 3cm). It surrounds the
urethra just below the urinary bladder and
can be felt during a rectal exam. It has
anterior, median, posterior and two lateral
lobes

• Relations: Posterior: rectal ampulla

(Denonvilliers’ fascia);Superior: bladder neck ;
Anterior:pubic symphysis (retropubic space
of Retzius); Inferior: urogenital diaphragm

• It’s work is regulated by androgens which are

responsible for male sex characteristics
 Anatomy and physiology
• Glandular cells produce milky fluid
that liquefies semen
• Smooth muscle cells, which contract
during sex and squeeze the fluid from
the glandular cells into the urethra,
where it mixes with sperm and other
fluids to make semen. The muscle
cells are stimulated by alpha
adrenergic receptors
• Stromal cells (which form the
structure of the prostate)
• The prostate gland also contains an
enzyme - 5 alpha-reductase that
converts testosterone to
dihydrotestosterone
 Zonal Anatomy

• Peripheral Zone 70% of the young adult

(60-70% of CaP)

• Central Zone 25% (5-10% CaP)

• Transition Zone 5% ( 10-20% CaP) BPH

Zonal Anatomy
 Microscopic Appearance
• Prostate consists of a thin fibrous capsule
under which are circulary oriented
smooth muscle fibres and collagenous
tissue. Prostatic stroma lies deep to this
layer and is composed of connective and
ellastic tissue and smooth muscle where
epithelial cells are embeded
• As a male ages, there are more likely to be
small concretions within the glandular
lumina, called corpora amylacea, that
represent laminated concretions of
prostatic secretions. The glands are
normally separated by stroma
• The thin layer of connective tissue that
surrounds the prostate merges with
surrounding soft tissues, including nerves