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Benign Prostatic Hyperplasia: Overview and Risk Factors

Benign prostatic hyperplasia (BPH) is the most common benign neoplasm of men. The stromal and, to a lesser degree, epithelial cells of the prostate become hyperplastic, causing the prostate to enlarge. The prevalence of BPH increases with age, rising from 8% in the third decade of life, to 40% to 50% in the fifth decade, to greater than 90% in the ninth decade. The etiology is multifactorial and not well understood. Testosterone and dihydrotestosterone, while necessary for BPH to occur, are not alone adequate to cause the condition. Research findings are unclear as to a possible pathogenic role of estrogen. Symptoms are related to obstruction of the urethra and include hesitancy, reduced urine flow rate, dribbling, urgency, frequency, and nocturia.

Risk Factors

The following factors are associated with increased risk of BPH:

Aging. BPH occurs more commonly with advancing age.

Family history. Data suggest a genetic link with an autosomal dominant pattern.1

Androgen. Higher androgen levels are associated with BPH.

Obesity. Excessive overweight may make detection more difficult via digital rectal examination (DRE). In addition, obesity, particularly abdominal obesity, may increase risk for BPH, presumably due to resultant hyperinsulinemia.2,3 Elevated levels of estrogens secondary to conversion from testosterone in adipose tissues may also play a role.

Physical inactivity. The Health Professionals Study and Massachusetts Male Aging Study found lower levels of physical activity to be associated with increased risk for BPH.4,5


Benign Prostatic Hyperplasia: Diagnosis and Treatment >>