Nodular prostatic hyperplasia

Nodular prostatic hyperplasia

•         Extremely common disorder in men above 50 yr. Its regarded as normal aging process.

•         Hyperplasia of both prostatic stroma & epithelial cells.

•         It occurs in periurethral region so caused partial or complete obstruction of urethra.

Pathogenesis:

The cause of NPH is Unknown

•         Dihydrotestosteron (DHT) a metabolite of testosterone act on nuclear androgen receptor on stromal & epithelial cells  signals a transcription of a growth factors stimulate proliferation & growth.

•         Estadiol (estrogen) level increase in elderly person which increase nuclear androgen receptor & possibly sensitize the prostate to the growth- promoting effects of DHT.

•         Grossly: increase weight of prostate (60-100 gm) with gray-white firm nodules affecting periurethral & transitional zones.

•         Histology: The earliest changes is a stromal proliferation in the periurethral portion of the prostate, this followed by  glandular proliferation .

•         Some glands are dilated or even cystic & often contain an inspissated secretion of glycoprotein nature (corpora amylacea) which is some times calcified.

•         Foci of squamous metaplasia & small areas of infarction some times are seen.

•         It is not consider as a premalignant lesion

•         Presentation: Difficulty in urination & retention of urine, cystitis, UTI and renal stones.

•         BPH requires testicular androgen during prostatic development.

•         Basic fibroblast growth factor, epidermal growth factor, keratinocyte growth factor, transforming growth factor-beta play some part in prostate growth.

•         Decreased endogenous apoptosis in prostate cause abnormal tissue growth in prostate.