The Pathophysiology of Benign Prostatic Hyperplasia

The prostate of aging males can be stimulated to undergo excessive growth. This is characterized by a number of cellular and molecular alterations leading to increased cell proliferation and reduced apoptosis in the prostate epithelium and stroma. The 'remodeling' that occurs as a result of these processes can permanently alter the appearance of the prostate, and may result in symptoms, long-term damage, and prostate cancer. It is not clear why these changes occur in some males, although it has been suggested that they are linked to a number of risk factors such as smoking, racial differences, obesity, liver cirrhosis, cardiovascular risks, and genetic predisposition. The pathogenesis of BPH is discussed in this section.

6.24.3.1 Genetics

A genetic involvement in the development and progression of BPH has been established. Molecular profiling using realtime quantitative reverse transcriptase-polymerase chain reaction on prostate tissue samples from BPH patients and normal controls has shown that at least 23 genes are upregulated and seven genes are downregulated in the BPH samples12; these altered gene expressions are shown in Table 2.

Table 2 Altered gene expression in BPH patients

Gene

Mean changea

Gene

Mean changea

Insulin-like growth factor 2

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