Histopathological aspects associated with the diagnosis of benign prostatic hyperplasia: Clinical implications

The histopathological diagnosis of benign prostatic hyperplasia (BPH) is very complex. We considered different histological aspects that may be included or associated with the diagnosis of BPH and which may be able to condition this disease: specifically, the stroma-epithelium ratio, the different expression of the neuroendocrine system and angiogenesis, inflammatory aspects, or other modifications considered preneoplastic lesions which may be present in tissue specimens obtained during BPH surgery. Both the Medline and Current Contents databases were used for this review. The searches were limited to reports published in the English literature from 1980 to 2001. Moreover four historical articles were referred to (see text). The description of all these variables, rather than just a simple diagnosis of BPH, helps the clinician in the management of the patient. A second important aspect is the effect of medical therapies on the different histological compartments of the prostate in BPH, particularly on the stroma-epithelium ratio. Several authors have analyzed the effects of alpha(1)-adrenoceptor blockers and 5alpha-reductase inhibitors on BPH tissue. Regarding preneoplastic lesions, there are at least three possible findings in the prostate that can also be found in association with BPH specimens: focal acinar atrophy, atypical adenomatous hyperplasia, and prostatic intraepithelial neoplasia. The last step is represented by the development of an incidental carcinoma. All these data confirm that there is a maintained interest in the histopathological analysis of BPH which needs to be kept in continuous consideration.