## Clinical Presentation & Diagnosis This patient presents with classic benign prostatic hyperplasia (BPH), confirmed by clinical, imaging, and laboratory findings. ### Key Diagnostic Features **Clinical:** - Age >65 years (peak incidence 7th–8th decade) - Lower urinary tract symptoms (LUTS): nocturia, weak stream, incomplete emptying - Smooth, firm, symmetrically enlarged prostate on DRE (no hard nodules) - Elevated post-void residual (120 mL) **Laboratory & Imaging:** - Normal PSA (2.8 ng/mL) — rules out malignancy - Transrectal ultrasound: homogeneous hypoechoic enlargement of **transitional zone** — pathognomonic for BPH - BPH arises from the transitional zone; adenocarcinoma typically arises from the peripheral zone ### Histopathology of BPH **Key Point:** BPH is characterized by **nodular hyperplasia** of both glandular (epithelial) and stromal (smooth muscle and fibroblasts) components. **Microscopic Features:** - Multiple nodules of hyperplastic glands (acini) lined by normal columnar epithelium - Hyperplastic smooth muscle and fibrous stroma - Compression of the urethra by nodular expansion - NO atypia, NO increased mitotic activity (benign) **Pathogenesis:** - Age-related increase in DHT (dihydrotestosterone) sensitivity - Growth factor signaling (FGF, EGF) driving stromal proliferation - Epithelial–stromal interaction **High-Yield:** BPH is **NOT premalignant** — it does not increase risk of adenocarcinoma, though both can coexist in older men. **Clinical Pearl:** The transitional zone (inner zone surrounding the urethra) is the exclusive site of BPH; the peripheral zone (outer zone) is where 70–75% of adenocarcinomas arise.
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