1. 5 September 2013 Dap Louw Urologist Life Beacon Bay Hospital

5. 2 main components: 1.Epithelial compartment -luminal secretory cells 2.Stromal compartment - structural support -smooth muscle, connective tissue α1-receptors blockers has effect on prostatic stroma

6. Free testosterone (2% of total) converted to DHT by 5alpha reductase enzyme in prostate DHT 1,5-2 X as potent as free testosterone - major androgen regulating prostate growth and differentiation

7. 5alpha reductase type I- skin, prostate epithelium + stroma typeII- prostate fibromuscular stroma Dutasteride (Avodart) inhibits type I&II Finasteride (Proscar) inhibits type II

8. Increase in stromal and epithelial cells in periurethral and transitional area Clinical symptoms not solely due to urethral resistance but also due to age related + outlet obstruction related detrusor dysfuntion ( detrusor instability and or decreased contactility) 25-30% of men will still urinary symptoms after releaving obstruction Active + passive forces play role in patophysiology. Alpha- blockade acts on active (dinamic) forces. Androgen blockade/surgery acts on passive forces (mechanical obstruction) Androgens do not cause BPH but is essential for development No correlation between prostate size, androgen concentration and urinary symptoms

9. Androgens- DHT not elevated but maintained in BPH. Androgen receptors and 5alpha reductase enzymes not downregulated with age Apoptosis Growth factors- VEGF,IGF,FGF,EGF. Hypoxia secondary to atherosclerosis induces HIF, FGF Inflammatory channels- source of growth factors Genetics – autosomal dominant (50% of men having surgery 60 yr). Higher prostate volume on average