Evolving Hypothesis that Prostate/BPH Size Matters in Protection against Prostate Cancer

Computerized metric assessment of glandular tissue volume within the peripheral zone of the prostate using combined magnetic resonance imaging and histopathology: Possible pathophysiological implications on prostate cancer development

“…As well documented in the literature, the prostate organ has four zones with the transition zone (TZ) and the peripheral zone (PZ) as the main ones [ 2 ]. Due to their different embryological origin these zonal structures also vary in biological behavior and clinical significance: The TZ is the primary site of BPH development, whereas the PZ accounts as the origin for by far the majority of all PCa cases (80%–85%) [ 3 4 5 ]. Recent studies suggested that the expanding TZ in growing BPH causes secondary glandular and connective tissue atrophy of the PZ, and thus may inhibit the development of PCa within the PZ [ 5 6 ].…”

“…In this context it is also interesting that numerous clinical studies reported an inverse relationship between BPH size and PCa incidence [ 5 7 8 ]. The here presented cohort study on prostates of various sizes uses a novel approach of combining magnetic resonance imaging (MRI) and histopathology metric parameters for elucidating pathophysiological changes that may explain a potential protective effect of increasing BPH/prostate size against PCa development.…”

The Origin of BPH and Prostate Cancer in Different Prostate Zones and the Impact on the Incidence of Prostate Cancer: A Systematic Review and Update of the Literature for Urologists and Clinicians

“…Among elderly men with a prostate condition, 95-98% who have "primary organ disease" have been diagnosed with benign prostatic hyperplasia (BPH), prostate cancer (PCa), or both. 1 Other primary diagnoses of the prostate, such as sarcoma, lymphoma, or metastases from other organ malignancies, have also been reported but are extremely rare. 1 PCa is currently the most common non-skin cancer and second most common cause of cancer-related mortality affecting men in the United States, after lung cancers.…”

“…1 Other primary diagnoses of the prostate, such as sarcoma, lymphoma, or metastases from other organ malignancies, have also been reported but are extremely rare. 1 PCa is currently the most common non-skin cancer and second most common cause of cancer-related mortality affecting men in the United States, after lung cancers. 2 Most men older than 50 have histological findings of BPH, 3 and more than 80% of patients with PCa also have histo-anatomical findings of BPH.…”

Editorial Commentary

“…Systematic review and meta-analysis studies on transrectal ultrasound and MRI have shown a highly significant negative association between prostate/BPH size and incidence of biopsy-proven PCa; no study was found showing the contrary. 1–3 Since this phenomenon and possible causes are controversially discussed, this should encourage researchers and clinicians to further investigate the dynamic interactions between the different prostatic zones in aging men with growing prostates. A better understanding of the cancer risks in the PZ and TZ could significantly influence future clinical management of both diseases, BPH and PCa alike.…”