Benign prostatic hyperplasia management - integrating pathophysiologic drivers with contemporary pharmacological and surgical paradigms: A translational review
Abstract
Benign Prostatic Hyperplasia (BPH) is an age-dependent, non-malignant proliferation of the prostatic transition zone that drives Lower Urinary Tract Symptoms (LUTS) and severely impairs quality of life in aging men. While traditionally viewed as a simple androgen-driven condition, its pathogenesis is now recognized as a complex, multifactorial process involving chronic inflammation, metabolic dysregulation and localized anatomical factors. Managing BPH effectively requires a translational framework that accurately pairs a patient's specific pathophysiological profile with targeted pharmacotherapy or contemporary, minimally invasive surgical interventions. Objectives To provide a comprehensive, translational synthesis of BPH management by mapping established and emerging etiological drivers to current clinical staging, pharmacological strategies and the rapidly evolving paradigm of minimally invasive surgical therapies (MISTs). Methods A narrative review of peer-reviewed clinical cohorts, landmark pharmacological trials and longitudinal surgical outcomes was conducted. Evidence regarding androgenic, metabolic, inflammatory and anatomical factors contributing to disease initiation and progression within the transition zone (TZ) was critically evaluated. Results Longitudinal data indicate that systemic androgens maintain prostatic homeostasis but are insufficient as isolated initiators of BPH. Emerging evidence suggests age-related metabolic dysregulation and chronic exposure…
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