Human benign prostatic hyperplasia: a stromal disease? New perspectives by quantitative morphology

Area of Science:

• Urology
• Pathology
• Cell Biology

Background:

• Benign prostatic hyperplasia (BPH) is characterized by abnormal prostate gland overgrowth.
• The stromal component of the prostate plays a critical role in BPH pathogenesis.
• Hormonal influences are implicated in the mechanisms driving prostate enlargement.

Purpose of the Study:

• To utilize stereology for a deeper understanding of BPH pathomorphogenesis.
• To investigate the hormonally controlled mechanisms behind prostate stromal overgrowth.
• To analyze ultrastructural changes in BPH.

Main Methods:

• Stereological analysis of prostate tissue.
• Ultrastructural examination of glandular cells.
• Comparative analysis between human and canine BPH models.

Main Results:

• A fourfold absolute increase in the stromal part and a nearly double increase in the glandular part of the prostate in human BPH.
• Consistent relative and absolute stromal increase in BPH, irrespective of individual variations.
• Reduced volume density of secretory droplets and lysosomes in glandular cells at the ultrastructural level.
• Evidence of smooth muscle cell activation, suggesting induced stromal growth.

Conclusions:

• Stromal overgrowth is a central and constant feature of BPH, indicating altered mesenchymal-epithelial interactions.
• Hormones like estrogen and/or androgen may induce stromal growth in BPH.
• Stereology provides valuable insights into the complex glandular-stromal interactions in BPH.