Epidemiology and Natural History of Benign Prostatic Hyperplasia

Lower urinary tract symptoms (LUTSs), often associated with an enlargement of the prostate, are common in men over 50 years old. At least 300,000 patients with LUTSs are treated annually by physicians in Japan, and this figure is expected to increase in the coming years. It is unlikely that all of these patients have clinical benign prostatic hyperplasia (BPH). BPH is a very complex, heterogeneous disease condition, in which urinary symptoms, prostate size, and urinary flow are not always interdependent. In addition to the heterogeneous nature of the disease, the causes of this disease may be multiple and heterogeneous. Hormonal factors, growth factors, stromalepithelial interaction, and aging are likely involved in the disease development.' The last decade has been fruitful for improving the understanding of the biology and pathophysiology of BPH, as well as the diagnosis and treatment of clinical BPH. Many experimental and clinical studies, although still incomplete, have clarified some aspects of the biology, which had been veiled in the past. However, more questions relating to basic and clinical issues have been raised concerning the diagnosis and treatment of BPH. In addition, clinical profiles of patients with BPH have dramatically changed over the last decade in Japan. Two decades ago, diagnosis and treatment for BPH was simple and straightforward. Most patients had typical, severe LUTSs, markedly impaired urinary flow, enlargement of the prostate, and a significant volume of residual urine. Treatment was by either of 2 surgical procedures that were the only effective treatment modality clinically proven at that time. These procedures, transurethral resection of the prostate (TURP) or (subcapsular) prostatectomy, yielded favorable outcomes in most patients. Currently, patients who visit urologists for LUTSs tend to have a widely distributed severity of symptoms, ranging from very mild to severe.2 They may have a prostate of normal size and a urinary flow rate

[1]  P. Iversen,et al.  A Point System for Selecting Operative Candidates , 1983 .

[2]  M. Becich,et al.  The relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostate hyperplasia. , 1992, The Journal of urology.

[3]  J. Oesterling,et al.  Natural history of prostatism: longitudinal changes in voiding symptoms in community dwelling men. , 1996, The Journal of urology.

[4]  Morton B. Brown,et al.  Urinary flow rates and voiding pressures in elderly men living in a community. , 1994, The Journal of urology.

[5]  P. Boyle,et al.  International comparison of the community prevalence of symptoms of prostatism in four countries. , 1996, European urology.

[6]  R. Clarke.  THE PROSTATE AND THE ENDOCRINES: A Control Series* , 1937 .

[7]  P. Boyle,et al.  Results of an epidemiological survey using a modified American Urological Association symptom index for benign prostatic hyperplasia in France. , 1994, The Journal of urology.

[8]  D. Byar.  BENIGN PROSTATIC HYPERPLASIA AND CANCER OF THE PROSTATE , 1975, The Lancet.

[9]  C. Barham,et al.  Who needs a prostatectomy? Review of a waiting list. , 1993, British journal of urology.

[10]  P. Abrams,et al.  The natural history of untreated "prostatism". , 1981, British journal of urology.

[11]  Y. Homma,et al.  Estimate Criteria for Efficacy of Treatment in Benign Prostatic Hyperplasia , 1996, International journal of urology : official journal of the Japanese Urological Association.

[12]  J. Isaacs.  Importance of the natural history of benign prostatic hyperplasia in the evaluation of pharmacologic intervention , 1990, The Prostate. Supplement.

[13]  T. Ichikawa,et al.  Natural course of human benign prostatic hyperplasia with relation to urinary disturbance , 1994, The Prostate.

[14]  P. Walsh,et al.  The development of human benign prostatic hyperplasia with age. , 1984, The Journal of urology.

[15]  D. S. Coffey,et al.  Etiology and disease process of benign prostatic hyperplasia , 1989, The Prostate. Supplement.

[16]  J. Oesterling,et al.  The prevalence of prostatism: a population-based survey of urinary symptoms. , 1993, The Journal of urology.

[17]  W. Garraway,et al.  High prevalence of benign prostatic hypertrophy in the community , 1991, The Lancet.

[18]  M. Akimoto.  [On the morphological alteration of the prostate gland in aging. II. A correlative histopathologic study of latent and manifested nodular hyperplasia of the prostate gland and senile changes of the testis]. , 1967, Nihon Hinyokika Gakkai zasshi. The japanese journal of urology.

[19]  H. Guess,et al.  Japanese men have smaller prostate volumes but comparable urinary flow rates relative to American men: results of community based studies in 2 countries. , 1996, The Journal of urology.

[20]  H H Zinsser,et al.  Natural history of benign prostatic hypertrophy and acute urinary retention. , 1976, Urology.

[21]  W. Hop,et al.  Natural history of benign prostatic hyperplasia: appropriate case definition and estimation of its prevalence in the community. , 1995, Urology.

[22]  H. Guess,et al.  Age-related differences in internal prostatic architecture on transrectal ultrasonography: results of a community based survey in Japan. , 1997, The Journal of urology.

[23]  P. Walsh,et al.  A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. , 1995, The Journal of urology.

[24]  H. Watanabe,et al.  Natural history of benign prostatic hypertrophy. , 1986, Ultrasound in medicine & biology.

[25]  J. Oesterling,et al.  Similar levels of urological symptoms have similar impact on Scottish and American men--although Scots report less symptoms. , 1993, The Journal of urology.

[26]  E. Metter,et al.  Symptoms and signs of prostatism as risk factors for prostatectomy , 1990, The Prostate.

[27]  W. Hop,et al.  Parameters of prostate volume and shape in a community based population of men 55 to 74 years old. , 1994, The Journal of urology.

[28]  H. Lepor,et al.  Comparison of the cellular composition of benign prostatic hyperplasia in Chinese and Caucasian-American men. , 1996, Urology.

[29]  David G. Bostwick,et al.  Urologic Surgical Pathology , 1997 .

[30]  C. C. Chen,et al.  Natural history of prostatism: urinary flow rates in a community-based study. , 1993, The Journal of urology.

[31]  K. Karube.  Study of latent carcinoma of the prostate in the Japanese based on necropsy material. , 1961, The Tohoku journal of experimental medicine.

[32]  H A Guess,et al.  Natural history of prostatism: impact of urinary symptoms on quality of life in 2115 randomly selected community men. , 1994, Urology.

[33]  H. Guess.  The Prevalence of Benign Prostatic Hyperplasia in Population Surveys , 1995 .

[34]  M. Barry,et al.  The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. , 1992, The Journal of urology.

[35]  W. Hop,et al.  The International Prostate Symptom Score in a community-based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate and residual urine volume. , 1995, British journal of urology.

[36]  G. Swyer.  Post-natal growth changes in the human prostate. , 1944, Journal of anatomy.

[37]  T. Stamey,et al.  Evolving patterns of tissue composition in benign prostatic hyperplasia as a function of specimen size. , 1990, Human pathology.

[38]  M. Barry,et al.  The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. , 1997, The Journal of urology.

[39]  G Jones,et al.  A new look at bladder neck obstruction by the food and drug administration regulators: guide lines for investigation of benign prostatic hypertrophy. , 1976, Transactions of the American Association of Genito-Urinary Surgeons.

[40]  H. Guess.  Benign prostatic hyperplasia: antecedents and natural history. , 1992, Epidemiologic reviews.

[41]  S. Akimoto,et al.  The natural history of benign prostatic hyperplasia. , 1997, Harvard men's health watch.

[42]  M. B. Brown,et al.  Epidemiology of bladder emptying symptoms in elderly men. , 1992, The Journal of urology.

[43]  J. Nickel,et al.  'Prostate-related symptoms' in Canadian men 50 years of age or older: prevalence and relationships among symptoms. , 1994, British journal of urology.

[44]  H. Guess,et al.  Prevalence of prostatism in Japanese men in a community-based study with comparison to a similar American study. , 1995, The Journal of urology.

[45]  E. Metter,et al.  Natural history of benign prostatichyperplasia and risk of prostatectomy , 1991 .

[46]  H. Watanabe,et al.  A survey of 3,000 examinations by transrectal ultrasonotomography , 1980, The Prostate.

[47]  S. Kaplan,et al.  Uroflowmetry and urodynamics. , 1995, The Urologic clinics of North America.

[48]  D. Hunter,et al.  Prevalence of urinary symptoms and other urological conditions in Spanish men 50 years old or older. , 1996, The Journal of urology.

[49]  Tetsuro Kato,et al.  [Histological study on hyperplasia of the prostate with special reference to histogenesis of nodule]. , 1967, Nihon Hinyokika Gakkai zasshi. The japanese journal of urology.

[50]  Y. Homma,et al.  Epidemiologic Survey of Lower Urinary Tract Symptoms in Asia and Australia Using the International Prostate Symptom Score , 1997, International journal of urology : official journal of the Japanese Urological Association.