Atrophy and proliferation in the young adult prostate

Atrophic and proliferative changes in the prostate gland are regarded as beginning in middle age and characterizing the prostates of older men. A total of 51 prostates of men between 19 and 29 years old demonstrated a spectrum of proliferative abnormalities, including ductal and glandular hyperplasia, atypical hyperplasia, dysplasia, carcinoma in situ and incipient adenocarcinoma. The majority of the prostates also contained substantial areas of atrophy. Patterns of atrophic change included cystic dilatation of glands with flattened epithelium apparently secondary to obstructive hyperplasia of ductal epithelium, areas comparable to sclerotic atrophy of the aged prostate and segments having the appearance of a prepubertal unstimulated prostate. These observations contrast sharply with conventional concepts of the biology of the prostate gland, and suggest a number of hypotheses regarding the early antecedents and evolution of prostatic carcinoma and cancer in general.