Epidemiology and pathogenesis of benign prostatic hyperplasia
- Glenn R Cunningham, MD
Glenn R Cunningham, MD
- Distinguished Professor Emeritus, Department of Medicine
- Baylor College of Medicine
- Dov Kadmon, MD
Dov Kadmon, MD
- Professor of Urology
- Baylor College of Medicine
Benign prostatic hyperplasia (BPH) is a common problem among older men, and is responsible for considerable disability. The large number of men with the symptoms of this disorder, the easy access to diagnostic tests, and the availability of drug therapy make it appropriate for the primary care provider to participate in the management of men with this disorder. To do so requires an appreciation for what is known regarding the epidemiology and etiology of BPH, which will be reviewed here. The diagnosis and management of this disorder are discussed elsewhere. (See "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia" and "Medical treatment of benign prostatic hyperplasia" and "Transurethral procedures for treating benign prostatic hyperplasia".)
The prostate on average weighs 20 grams in normal 21- to 30-year-old men, and the weight changes little thereafter unless the man develops BPH . However, because of the increased prevalence of BPH in older men, the mean prostate weight at autopsy increases after age 50 years (figure 1).
Prevalence — The prevalence of histologically diagnosed prostatic hyperplasia increases from 8 percent in men aged 31 to 40, to 40 to 50 percent in men aged 51 to 60, to over 80 percent in men older than age 80 (figure 2). The Baltimore Longitudinal Study of Aging compared the age-specific prevalence of pathologically defined BPH at autopsy with the clinical prevalence based upon history and the results of digital rectal examination . There was good agreement between the clinical prevalence and autopsy incidence in men of all ages.
A major difficulty in comparing the prevalence of lower urinary tract symptoms (LUTS) among different groups has been the lack of a common definition. The Olmsted County study found the prevalence of moderate or severe LUTS for men in the fifth, sixth, seventh, and eighth decades of life to be 26, 33, 41, and 46 percent, respectively . In a community-based group of 502 men aged 55 to 74 years without prostate cancer, the prevalence of BPH and LUTS was 19 percent using the criteria of a prostate volume above 30 mL and a high International Prostate Symptom Score (IPSS) . However, the prevalence was only 4 percent if the criteria were a prostate volume above 30 mL, a high International Prostate Symptom Score (IPSS), a maximal urinary flow rate below 10 mL/sec, and a post-void residual urine volume greater than 50 mL. (See "Lower urinary tract symptoms in men".)
●Race – Race has some influence on the risk for BPH severe enough to require surgery. While the age-adjusted relative risk (RR) of BPH necessitating surgery is similar in black and white men, black men less than 65 years old may need treatment more often than white men . In a study of 34,624 men, compared with whites, Asians had a lower risk for nocturia (RR 0.7, 95% CI 0.5-0.9), physician diagnosed BPH (RR 0.7, CI 0.2-0.5), and transurethral prostate surgery (RR 0.2, CI 0.1-0.6), while risks for blacks and whites were similar . In the American Male Health Professional Study, men of Asian ancestry were less likely (relative risk 0.4, 95% CI 0.2-0.8) to undergo surgery for BPH as compared with white men . Black men had similar risk to white men in this study. In a community sample of 2480 men in the United States, moderate to severe LUTS were more common in blacks than in whites (41 versus 34 percent) , and blacks had greater total and transitional zone prostate volume [9,10]. However, there is evidence that differences in risk of LUTS is more related to socioeconomic factors such as income and insurance than to race .
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