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    • Natural history of benign prostatic hyperplasia prior to dia

    2018-10-22

    Natural history of benign prostatic hyperplasia prior to diagnosis Benign prostatic hyperplasia (BPH) is the most common nonmalignant condition of the prostate developing in aging men. BPH is a major public health concern, causing high morbidity and substantial worsening of men\'s quality of life (QOL). The prevalence rates of BPH mostly depend on the parameters used in a case definition. In Japan, these rates have been estimated on the basis of the results of community-based studies. Six percent and 12% of Japanese men in their 60s and 70s, respectively, met all of the following criteria for BPH: (1) an international prostate symptom score (IPSS) >7 points; (2) prostate volume (PV) >20 mL; and (3) peak urinary flow rate (Qmax) <10 mL/s. Only 2% of men in their 40s and 50s met the aforementioned criteria. The principal risk factors for BPH are aging and the hormone produced from normally functioning testes. Although no definitive naloxone hydrochloride responsible for BPH have been identified, a family history of BPH and molecular abnormalities may increase the likelihood of the development of BPH. Dietary factors, such as isoflavonoids and lignans in vegetables, grains, and soy, may negatively affect the development of BPH. Furthermore, recent studies have claimed a relationship between metabolic syndrome and BPH. A normal prostate weighs 20 ± 6 g in men aged 21–30 years, and this weight remains essentially constant with increasing age unless BPH develops. The prevalence of pathological BPH is 8% in the 4th decade of life; however, 50% of men develop pathological BPH at age 51–60 years. The average weight of a prostate identified at autopsy as having BPH is 33 ± 16 g. Only 4% of the prostates in men older than 70 years weigh >100 g. An analysis of a logistic growth curve of BPH lesions removed at prostatectomy indicates that the growth of BPH is initiated probably before the patient is 30 years. The early phase of BPH growth (in men aged 31–50 years) is characterized by a doubling time for the tumor weight of 4.5 years. In the mid-phase of BPH growth (in men aged 51–70 years), the doubling time is 10 years and increases to >100 years in patients older than 70 years. BPH is a physiological process that occurs with aging, regardless of race, ethnicity, or region. Estimated rates of prostate growth increased with increasing age. However, the estimated average annual change was 1.6% across all age groups. Estimated rates of prostate growth are high, depending on the baseline PV, with higher growth rates for men with larger prostates. BPH is a progressive disease in a certain proportion of men older than 50 years. Men showing prostate growth are at a greater risk of symptomatic deterioration. Men with no prostate growth are significantly more likely to improve symptomatically. The prevalence of lower urinary tract symptoms (LUTS) in the general population is age-related. Longitudinal studies have shown an increase in the IPSS with aging as a whole but with simultaneous decreases in the IPSS in certain subgroups. Qmax decreases with aging, and this may be attributable to benign prostatic obstruction and detrusor underactivity. In addition, longitudinal studies have confirmed age-related increases in prostate volume (PV), although PV decreased with aging in a small proportion of men. Recent studies have indicated that PV may increase in men in whom the prostate has a visible transition zone with a clear border and those in whom transrectal ultrasound shows a large transition zone volume at baseline. In general, the relationship among LUTS, urinary flow rate, and PV is poor in men presenting at hospitals, but the relationship is modest in the general population. Prostate enlargement may be involved in the progression of symptoms of BPH.
    Factors affecting health care-seeking behavior A cross-sectional, population-based cohort study in Olmsted County, MN, USA, revealed that health care-seeking behavior is influenced by symptom severity, particularly if the symptoms are bothersome and interfere with a patient\'s daily activities. While symptom severity is a vital determinant of health care-seeking behavior in men with urinary symptoms, age-related factors may drive men to seek care for urinary symptoms. Men aged 70–79 years were 4.6 times more likely (95% confidence interval, 2.1–10.1) than those aged 40–49 years to have sought health care because of urinary symptoms. Seventy-six percent of men who had sought medical care had prostate enlargement, depressed peak urine flow rates, and moderate-to-severe symptoms of BPH (sensitivity). By contrast, only 55% of men who did not seek health care for urinary symptoms had mild symptoms of BPH, normal prostatic volume, and normal peak urine flow rates (specificity). Clinical, physiological, and anatomic measures of prostatism do not adequately distinguish the men who seek medical care for their urinary symptoms from those who do not.