Aetiological Factors in Benign Prostatic Hyperplasia

  • S. Shepherd


Benign prostatic hyperplasia (BPH) is emerging as a significant public health problem as the high prevalence of the disease is becoming increasingly recognised. In order to minimise the morbidity, mortality and economic burden from BPH it is important to delineate its causal factors so that appropriate intervention is undertaken where feasible. The aetiology of BPH is not fully understood, and additional research at biochemical, pathological, clinical and epidemiological levels is required. This chapter outlines the contribution of epidemiology to elucidating the aetiological factors known to date. It begins with a general discussion on risk factors and disease causation. This is followed by a review of the important methodological difficulties encountered in the investigation of BPH. Finally, the evidence for individual risk factors is presented.


Benign Prostatic Hyperplasia Aetiological Factor Prostatic Hypertrophy Benign Prostatic Hypertrophy Baltimore Longitudinal Study 
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  1. Aldercreutz H (1988) Lignans and phytoestrogens. Possible preventive role in cancer. In: Rozen P, Hortwitz C (eds) Frontiers in gastrointestinal research. Karger, Basel, pp 165–176.Google Scholar
  2. Anderson JT, Nordling J, Walter S (1979) Prostatism 1. The correlation between symptoms, cystometric and urodynamic findings. Scand J Urol Nephrol 13:229–236Google Scholar
  3. Anderson KE, Kappas A (1982) Hormones and liver function. In: Schiff L, Schiff ER (eds) Diseases of the liver. Lippincott, Philadelphia, pp 167–236Google Scholar
  4. Araki H, Watanabe H, Mishina T, Nakao H (1983) High-risk group for benign prostatic hypertrophy. Prostate 4:253–264PubMedCrossRefGoogle Scholar
  5. Armenian HK, Lilienfeld AM, Diamond EL, Bross IDJ (1975) Epidemiological characteristics of patients with prostatic neoplasms. Am J Epidemiol 102:47–54PubMedGoogle Scholar
  6. Arrighi HM, Metter EJ, Guess HA, Fozzard JL (1991) Natural history of benign prostatic hyperplasia and risle of prostatectomy. Urology 38[Suppl]:4–8PubMedCrossRefGoogle Scholar
  7. Arrighi HM, Guess HA, Metter EJ, Fozzard JL (1990) Symptoms and signs of prostatism as risk factors for prostatectomy. Prostate 16:253–261PubMedCrossRefGoogle Scholar
  8. Ashley DJ (1966) Observations of the epidemiology of prostatic hyperplasia in Wales. Br J Urol 38:567–569PubMedCrossRefGoogle Scholar
  9. Ball AJ, Feneley RCL, Abrams PM (1981) The natural history of untreated prostatism. Br J Urol 53:613–616PubMedCrossRefGoogle Scholar
  10. Barnes BA, O’Brien E, Comstock C, D’Arpa DG, Donahue CL (1985) Report on variation in rates of utilization of surgical services in the commonwealth of Massachusetts. JAMA 254:371–375PubMedCrossRefGoogle Scholar
  11. Barnes RW, Marsh C (1983) Progression of obstruction and symptoms. In: Hinman F Jr (ed) Benign prostatic hypertrophy. Springer, Berlin Heidelberg New York, pp 711–713CrossRefGoogle Scholar
  12. Barrett-Connor E (1990) Smoking and endogenous sex hormones in men and women. In: Wald N, Baron J (eds) Smoking and hormone related disorders. Oxford University Press, Oxford, pp 183–196Google Scholar
  13. Barrett-Connor E, Khaw K-T (1987) Cigarette smoking and increased endogenous estrogen levels in men. Am J Epidemiol 126:187–192PubMedCrossRefGoogle Scholar
  14. Barry MJ (1990) Epidemiology and natural history of benign prostatic hyperplasia. Urol Clin North Am 17:495–507PubMedGoogle Scholar
  15. Barry MJ, Boyle P, Garraway M et al (1993) Epidemiology and natural history of BPH. In: Cockett ATK, Khoury S, Aso Y et al (eds) Proceedings of the 2nd International Consultation on Benign Prostatic Hyperplasia (BPH). WHO, Geneva, pp 19–28Google Scholar
  16. Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479PubMedGoogle Scholar
  17. Birkhoff JD, Wiederborn AR, Hamilton MC, Einssen HM (1976) Natural history of benign prostatic hypertrophy and acute urinary retention. Urology 7:48–52PubMedCrossRefGoogle Scholar
  18. Bostwick DG, Sole Balcells F, Cooner WH et al (1992) Benign prostatic hyperplasia (BPH) and cancer of the prostate. In: Cockett ATK, Aso Y, Chatelain C et al (eds) Proceedings of the International Consultation on Benign Prostatic Hyperplasia (BPH). WHO, Geneva, pp 139–159Google Scholar
  19. Bourke JB, Griffin JP (1966) Hypertension, diabetes mellitus, and blood groups in benign prostatic hypertrophy. Br J Urol 38:18–23PubMedCrossRefGoogle Scholar
  20. Boyle P, McGinn R, Maisonneuve P, La Vecchia C (1991) Epidemiology of benign prostatic hyperplasia: present knowledge and studies needed. Eur Urol 20[Suppl 2]:3–10PubMedGoogle Scholar
  21. Bradford-Hill A (1965) The environment and disease: association or cause? Proc R Soc Med 58:295Google Scholar
  22. Briggs MH (1973) Cigarette smoking and infertility in men. Med J Aust 1:616–617PubMedGoogle Scholar
  23. Chang HL, Char GY (1936) Benign hypertrophy of the prostate. Chin Med J 50:1707–1722Google Scholar
  24. Chopra IJ, Tulchinsky D, Greenway FL (1973) Estrogen-androgen imbalance in hepatic cirrhosis. Ann Intern Med 79:198–203PubMedGoogle Scholar
  25. Chyou P-H, Nomura AMY, Stemmermann GN, Hankin JH (1993) A prospective study of alcohol, diet, and other lifestyle factors in relation to obstructive uropathy. Prostate 22:253–264PubMedCrossRefGoogle Scholar
  26. Clarke R (1937) The prostate and the endocrines. A control series. Br J Urol 9:254–271Google Scholar
  27. Craigen AA, Hickling JB, Saunders CR, Carpenter RJ (1969) Natural history of prostatic obstruction. J R Coll Gen Pract 18:226–232PubMedGoogle Scholar
  28. Dai WS, Gutai JP, Kuller LH, Cauley JA, for the MRFIT Research Group (1988) Cigarette smoking and serum sex hormones in men. Am J Epidemiol 128:796–805PubMedGoogle Scholar
  29. D’Aunoy R, Schenken JR, Burns EL (1939) The relative incidence of hyperplasia of the prostate in white and coloured races in Louisiana. South Med J 32:47–52CrossRefGoogle Scholar
  30. Danieli HW (1993) Larger prostatic adenomas in obese men with no associated increase in obstructive uropathy. J Urol 149:315–317Google Scholar
  31. de la Torre B, Hedman M, Jensen F, Pedersen PH, Diczfaluzy E (1983) Lack of effect of vasectomy on peripheral gonadotrophins and steroid levels. Int J Androl 6:125–134PubMedCrossRefGoogle Scholar
  32. Derbes VDP, Leche Sm, Hooker CW (1937) The incidence of benign prostatic hypertrophy amongst the whites and negroes in New Orleans. J Urol 38:383–388Google Scholar
  33. Diokno AC, Brown MB, Goldstein N, Herzog AR (1992) Epidemiology of bladder emptying symptoms in elderly men. J Urol 148:1817–1821PubMedGoogle Scholar
  34. Ekman P (1989) BPH epidemiology and risk factors. Prostate [Suppl] 2:23–31CrossRefGoogle Scholar
  35. Eldrup E, Lindholm J, Winkel P (1987) Plasma sex hormones and ischaemic heart disease. Clin Biochem 20:105–112PubMedCrossRefGoogle Scholar
  36. Farnsworth WE, Slaunwhite WR, Sharma M et al (1981) Interactions of prolactin and testosterone in the human prostate. Urol Res 9:79–88PubMedCrossRefGoogle Scholar
  37. Fletcher RH, Fletcher SW, Wagner EH (1988) Clinical epidemiology. The essentials, 2nd edn. Williams and Wilkins, BaltimoreGoogle Scholar
  38. Frea B, Annoscia S, Santa G, Lozzi C, Carmignani G (1987) Correlation between liver cirrhosis and benign prostatic hyperplasia: a morphological study. Urol Res 15:311–314PubMedCrossRefGoogle Scholar
  39. Garraway WM, Collins GN, Lee RJ (1991) High prevalence of benign prostatic hypertrophy in the community. Lancet 338:469–471PubMedCrossRefGoogle Scholar
  40. Ghose RR, Harindra V (1989) Unrecognised high pressure chronic retention of urine presenting with systemic arterial hypertension. BMJ 298:1626–1628PubMedCrossRefGoogle Scholar
  41. Glynn RJ, Campion EW, Bouchard GR, Silbert JE (1985) The development of benign prostatic hyperplasia among volunteers in the Normative Aging Study. Am J Epidemiol 121:78–90PubMedGoogle Scholar
  42. Gordon GG, Altman K, Southren AL, Rubin E, Lieber CS (1976) Effect of alcohol (ethanol) administration on sex-hormone metabolism in normal men. N Engl J Med 295:793–797PubMedCrossRefGoogle Scholar
  43. Gover M (1923) A statistical study of the etiology of benign hypertrophy of the prostate gland. John Hopkins Hosp Rep 21:231–295Google Scholar
  44. Greenwald P, Kirmass V, Polan AK, Dick VS (1974) Cancer of the prostate among men with benign prostatic hyperplasia. J Natl Cancer Inst 53:335–340PubMedGoogle Scholar
  45. Guess HA (1992) Benign prostatic hyperplasia: antecedents and natural history. Epidemiol Rev 14:131–153PubMedGoogle Scholar
  46. Huggins C, Stevens R (1940) The effect of castration on benign hypertrophy of the prostate in man. J Urol 43:705–714Google Scholar
  47. Isaacs JT, Coffey DS (1989) Etiology and disease process of benign prostatic hyperplasia. Prostate [Suppl] 2:33–50CrossRefGoogle Scholar
  48. Jakobsen H, Torp PS, Juul N, Hald T (1988) The long term influence of vasectomy on prostatic volume and morphology in man. Prostate 13:57–67PubMedCrossRefGoogle Scholar
  49. Jones DA, George NJR, O’Reilly PH, Barnard RJ (1987) Reversible hypertension associated with unrecognised high-pressure chronic retention of urine. Lancet 1:1052–1054PubMedCrossRefGoogle Scholar
  50. Kambal A (1977) Prostatic obstruction in Sudan. Br J Urol 49:139–141PubMedCrossRefGoogle Scholar
  51. Lee C, Jesik C (1983) Effects of castration, estrogen, and androgen administration. In: Hinman FH Jr (ed) Benign prostatic hypertrophy. Springer, Berlin Heidelberg New York, pp 229–334CrossRefGoogle Scholar
  52. Lissoos I (1973) Simple prostatic hyperplasia in the Bantu. S Afr Med J 47:389–391PubMedGoogle Scholar
  53. Lytton B (1983) Interracial incidence of benign prostatic hypertrophy. In: Hinman FH Jr (ed) Benign prostatic hypertrophy. Springer, Berlin Heidelberg New York, pp 22–26CrossRefGoogle Scholar
  54. Lytton B, Emery JM, Harvard BM (1968) The incidence of benign prostatic hypertrophy. J Urol 99:639–645PubMedGoogle Scholar
  55. Matzin H, Soloway MS (1993) Cigarette smoking: a review of possible associations with benign prostatic hyperplasia and prostate cancer. Prostate 22:277–290CrossRefGoogle Scholar
  56. McNeal JE (1978) Origin and evolution of benign prostatic enlargement. Invest Urol 15:340–345PubMedGoogle Scholar
  57. McPherson K, Wennberg JE, Hovind OB, Clifford P (1982) Small-area variations in the use of common surgical procedures: an international comparison of New England, England and Norway. N Engl J Med 307:1310–1314PubMedCrossRefGoogle Scholar
  58. Meyhoff HH, Hald T (1979) Are doctors able to assess prostatic size? Scand J Urol Nephrol 13:229CrossRefGoogle Scholar
  59. Meyhoff HH, Ingeman L, Nordling J (1981) Accuracy in preoperative estimation of prostatic size: a comparative evaluation of rectal palpation, intavenous pyelography, urethral closure pressure profile recording and cystourethroscopy. Scand J Urol Nephrol 15:45–51PubMedCrossRefGoogle Scholar
  60. Moore RA (1943) Benign hypertrophy of the prostate. A morphological study. J Urol 50:680–710Google Scholar
  61. Morrison AS (1978) Prostatic hypertrophy in Greater Boston. J Chronic Dis 31:357–362PubMedCrossRefGoogle Scholar
  62. Morrison AS (1990) Smoking and prostatic hypertrophy. In: Wald N, Baron J (eds) Smoking and hormone related disorders. Oxford University Press, Oxford, pp 183–196Google Scholar
  63. Morrison AS (1992) Risk factors for prostatic hypertrophy. Am J Epidemiol 135:974–980PubMedGoogle Scholar
  64. Movsas S (1966) Prostatic obstruction in the african and asiatic. Br J Surg 53:538–543PubMedCrossRefGoogle Scholar
  65. Nomura AMY, Kolonel LN (1991) Prostate cancer: a current perspective. Epidemiol Rev 13:200–227PubMedGoogle Scholar
  66. Partin AW, Oesterling JE, Epstein JI, Horton R, Walsh PC (1991) The influence of age and endocrine factors on the volume of benign prostatic hyperplasia. J Urol 145:405–409PubMedGoogle Scholar
  67. Peters CA, Walsh PC (1987) The effects of nafarelin acetate, a luteinizing hormone-releasing hormone agonist, on benign prostatic hyperplasia. N Engl J Med 317:599–604PubMedCrossRefGoogle Scholar
  68. Pierrepoint CG (1975) Does hormone transfer along the vas deferentia contribute of the control of prostatic function and could it be a factor in the etiology of prostatic hyperplasia? In: Goland M (ed) Normal and abnormal growth of the prostate. Thomas, Springfield, pp 517–529Google Scholar
  69. Randall A (1931) Surgical pathology of prostatic obstructions. Williams and Wilkins, Baltimore, pp 11–16Google Scholar
  70. Richardson IM (1964) Prostatic hyperplasia and social class. Br J Prev Soc Med 18:157–162PubMedGoogle Scholar
  71. Roehrborn CG (1993) Objective and subjective response criteria to diagnose benign prostatic hyperplasia. Eur Urol 24[Suppl 1]:2–11PubMedGoogle Scholar
  72. Ross RK, Bernstein L, Paganini-Hill A, Henderson BE (1990) Effects of cigarette smoking on hormone-related disease in a southern California retirement community. In: Wald N, Baron J (eds) Smoking and hormone related disorders. Oxford University Press, Oxford, pp 32–54Google Scholar
  73. Seitter WR, Barrett-Connor E (1992) Cigarette smoking, obesity, and benign prostatic hypertrophy: a population-based study. Am J Epidemiol 135:500–503PubMedGoogle Scholar
  74. Shaaraway M, Mahmoud KZ (1982) Endocrine profile and semen characteristics in male smokers. Fertil Steril 38:255–257Google Scholar
  75. Sidney S (1987) Vasectomy and the risk of prostatic cancer and benign prostatic hypertrophy. J Urol 138:795–797PubMedGoogle Scholar
  76. Sidney S, Quesenberry C Jr, Sadler MC, Lydick EG, Guess HA, Cattolica EV (1991a) Risk factors for surgically treated benign prostatic hyperplasia in a prepaid health care plan. Urology 38[Suppl 1]:13–19PubMedCrossRefGoogle Scholar
  77. Sidney S, Quesenberry C Jr, Sadler MC, Guess HA, Lydick EG, Cattolica EV (1991b) Incidence of surgically treated benign prostatic hypertrophy and of prostate cancer among blacks and whites in a prepaid health care plan. Am J Epidemiol 134:825–829PubMedGoogle Scholar
  78. Steele R, Lees REM, Kraus AS, Rao C (1971) Sexual factors in the epidemiology of cancer of the prostate. J Chronic Dis 24:29–37PubMedCrossRefGoogle Scholar
  79. Stephenson WP, Chute CG, Guess HA, Schwartz S, Lieber M (1991) Incidence and outcome of surgery for benign prostatic hyperplasia among residents of Rochester, Minnesota: 1980-1987. A population-based study. Urology 38[Suppl l]:32–42PubMedCrossRefGoogle Scholar
  80. Stumpf HH, Wilens SL (1953) Inhibitory effects of portal cirrhosis of liver on prostatic enlargement. Arch Intern Med 91:304–309Google Scholar
  81. Syms AJ, Harper ME, Griffiths K (1985) The effect of prolactin on human BPH epithelial cell proliferation. Prostate 6:145–153PubMedCrossRefGoogle Scholar
  82. Teboul F, Ecochard R, Colin C, Matillon Y, Berger N, Urol College of Lyon (1991) Descriptive analysis of a series of operations for prostatic adenomas in inhabitants of Lyon, France, in 1988. Eur Urol 20[Suppl 2]:18–21PubMedGoogle Scholar
  83. Turner-Warwick RT, Whiteside CG, Arnold EP et al (1973) A urodynamic view of prostatic obsturction and the results of prostatectomy. Br J Urol 45:631–639CrossRefGoogle Scholar
  84. Walsh PC (1992) Benign prostatic hyperplasia. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED Jr (eds) Campbell’s urology, 6th edn. Saunders, Philadelphia, pp 1009–1025Google Scholar
  85. Walsh PC, Wilson JD (1976) The induction of prostatic hypertrophy in the dog with and— rostanediol. J Clin Invest 57:1093–1097PubMedCrossRefGoogle Scholar
  86. Watanabe H, Date S, Ohe H (1980) A survey of 3000 examinations by transrectal ultrasonography. Prostate 1:271–278PubMedCrossRefGoogle Scholar
  87. Wennberg JE, Barnes BA, Zubkoff M (1982) Professional uncertainty and the problem of supplier induced demand. Soc Sci Med 16:811–824PubMedCrossRefGoogle Scholar
  88. Wennberg JE, Mulley AG Jr, Hanley D et al (1988) An assessment of prostatectomy for benign urinary tract obstruction. Geographic variations and the evaluation of medical care outcomes. JAMA 259:3027–3030Google Scholar
  89. WHO (1986) World health statistics annual. WHO, GenevaGoogle Scholar
  90. Wilson JD (1980) The pathogenesis of benign prostatic hyperplasia. Am J Med 68:745–756PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1995

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  • S. Shepherd

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