Benign Prostatic Hyperplasia‐ what do we know?

Objectives Benign prostatic hyperplasia (BPH) is a prevalent disease with significant health and economic impacts on individuals and health organisations across the world, whilst the cause/initiation of the disease process has still not been fully determined METHODS: This review presents historical and contemporary hypotheses on the pathogenesis of benign prostatic hyperplasia, with the potential implications in regards to current medical therapies. Results In BPH, pathways involving androgens, oestrogens, insulin, inflammation, proliferative reawakening, stem cells and telomerase have been hypothesised in the pathogenesis of the disease. A number of pathways first described over 40 years ago have been first rebuked and then have come back into favour. A system of an inflammatory process within the prostate, which leads to growth factor production, stem cell activation and cellular proliferation encompasses a number of pathways and is currently in vogue. This review also highlights the physiology of the prostate cell subpopulations and how this may account for the delay/failure in treatment response for certain medical therapies. Conclusion BPH is an important disease, of which the pathogenesis is not fully understood that impacts the effectiveness of medical therapies. This impacts patients, with further research potentially highlighting novel therapeutic avenues.