The Relative Proportion of Stromal and Epithelial Hyperplasia is Related to the Development of Symptomatic Benign Prostate Hyperplasia

Abstract

The specific features of the prostate adenoma predisposing to the development of symptomatic benign prostatic hyperplasia (BPH) are unknown. Our objective was to determine whether the histological composition of the prostate adenoma is related to the development of symptomatic BPH. Prostate adenomas were obtained from men with asymptomatic BPH undergoing cystoprostatectomy for invasive transitional cell carcinoma, and from men with symptomatic BPH undergoing open prostatectomy, transurethral resection of the prostate and pharmacotherapy. The severity of bladder outlet obstruction was evaluated with the Boyarsky symptom score and uroflowmetry. The percentages of stroma, epithelium and glandular lumen were determined in the prostate adenomas via quantitative image analysis on a computer-assisted morphometry system. The prostate adenomas from the 33 men with symptomatic BPH contained 62 +/- 1%, 15 +/- 1% and 23 +/- 1 of stroma, epithelium and glandular lumen, respectively. The prostate adenomas from 6 men with asymptomatic disease contained 54 +/- 1%, 21 +/- 1% and 25 +/- 1% of stroma, epithelium and glandular lumen, respectively. The ratios of stromal-to-epithelial hyperplasia in the prostate adenomas from men with symptomatic and asymptomatic disease were 4.6 +/- 0.3 and 2.7 +/- 0.1, respectively. The differences in percentage of stroma and epithelium, and the stromal-to-epithelial ratio in the prostate adenomas from men with symptomatic and asymptomatic BPH were statistically significant. Our study suggests that the histological composition of the prostate adenoma is related to the development of symptomatic BPH.

Pathology of benign prostatic hyperplasia

“…Studies from primarily small-resected glands show a predominance of fibromuscular stroma. 23 Larger Importance of smooth muscle Regardless of the exact proportion of epithelial to stromal cells in the hyperplastic prostate, there is no question that prostatic smooth muscle represents a significant volume of the gland. 24 Although the smooth muscle cells in the prostate have not been extensively characterized, presumably their contractile properties are similar to those seen in other smooth muscle organs.…”

High Concentration of Reticular Fibers in Periurethral Region of the Prostatic Urethra from Patients with Benign Prostatic Hyperplasia as Revealed by Stereology

“…Thus, there are several conflicting opinions concerning the relationship between the size of the hyperplastic prostate and the grade of urethral compression (Shapiro et al, 1992;Kaplan et al, 1995;Terris et al, 1998;Ichiyanagi et al). The relationship between the International Prostate Symptom Score (IPSS) and the prostate total volume suggests that the bigger prostate impinges more making the symptoms more severe (Kojima et al, 1997).…”

Benign Prostat Hiperplazisi

“…Hiperplazi hem glandüler hem de stromal elemanlarda olmasına rağmen primer olarak fibromüsküler stromada artışla başladığına inanılmaktadır [7,8]. BPH gerçek anlamda hiperplastik bir süreç-tir ve histolojik çalışmalar hücre sayısında artışı göstermektedir [9].…”

“…İkinci fazda nodüller büyürken glandüler nodül-lerin boyutları daha büyüktür. Glandüler ve stromal elemanların oranında belirgin pleomorfizm vardır [12]. Stromal nodüller histolojik olarak iyi sınırlıdır ve immatür mezankimal, fibrolastik, fibromusküler veya düz kas şeklindedir [13].…”