Regarding benign prostatic hyperplasia (BPH), all of the following statements are correct EXCEPT:

Question

Accepted Answer

D. It is a malignant condition with high risk of progression to adenocarcinoma if left untreated. ## Benign Prostatic Hyperplasia (BPH) — Pathology Overview

### Definition & Epidemiology

**Key Point:** BPH is a benign proliferative disorder of the prostate that increases in prevalence with age, affecting >50% of men >60 years. It is NOT a premalignant condition and does NOT increase the risk of prostate cancer.

### Pathogenesis

1. **Androgen dependence**: DHT (dihydrotestosterone), produced by 5α-reductase conversion of testosterone, is the key driver of BPH growth.
2. **Zone of origin**: Arises from the **transition zone** (periurethral glands), not the peripheral zone where most adenocarcinomas arise.
3. **Growth factors**: Increased expression of FGF, EGF, and IGF-1 promotes stromal and epithelial proliferation.

### Histopathology

| Feature | BPH | Adenocarcinoma |
|---------|-----|----------------|
| **Basal cell layer** | Intact, preserved | Absent/disrupted |
| **Architecture** | Organized glands, nodular | Infiltrative, disorganized |
| **Cytology** | Benign nuclei, normal mitoses | Atypical nuclei, increased mitoses |
| **Stromal component** | Smooth muscle hyperplasia | Desmoplastic stroma |

**High-Yield:** The presence of an **intact basal cell layer** on immunohistochemistry (using p63 or 34βE12) is a key feature that distinguishes benign from malignant glandular proliferation.

### Clinical Significance

**Clinical Pearl:** BPH and prostate cancer are independent entities. A patient with BPH is NOT at increased risk of developing adenocarcinoma. They may coexist, but one does not transform into the other.

**Warning:** Do not confuse BPH with prostatic intraepithelial neoplasia (PIN) or adenocarcinoma — these are separate pathological entities with different etiologies and prognoses.

### Why the Incorrect Option is Wrong

Option 4 states that BPH is "malignant" with "high risk of progression to adenocarcinoma" — this is **FALSE**. BPH is benign by definition and does not transform into cancer. It may cause lower urinary tract symptoms (LUTS) and urinary obstruction, but malignant transformation does NOT occur.

[cite:Robbins 10e Ch 20]

Answer

A. Histologically, it is characterized by increased stromal and glandular proliferation with intact basal cell layer

Answer

B. It arises from the transition zone of the prostate and causes urinary obstruction

Answer

C. DHT (dihydrotestosterone) is the primary androgen driving its pathogenesis

Regarding benign prostatic hyperplasia (BPH), all of the following statements are correct EXCEPT:

Explanation

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