Introduction

Benign prostatic hypertrophy/hyperplasia (BPH) is the histological cause of benign prostatic enlargement; it is a common cause of lower urinary tract symptoms (LUTS) in men, usually over the age of 40.1,2 An increase in prostatic smooth muscle tone (dynamic component) and an increase in benign prostatic tissue narrowing of the urethral canal (static component) are the two main components.3 BPH affects nearly all men at some stage, however, some men remain asymptomatic.2 BPH is usually not life-threatening but can have a significant effect on quality of life (QoL).4

Global estimates of BPH vary.5,6,7 In Australia between 2009 and 2011, more than 200,000 cases of BPH were managed by general practitioners (GPs) in the community.1

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

  • Discuss the pathophysiology of benign prostatic hypertrophy (BPH)
  • Describe the symptoms and diagnosis of BPH
  • Explain pharmacological and non-pharmacological management options available for BPH, including complementary medicines
  • Counsel on effective medicines use to ensure best patient outcomes.

Competency standards (2016) addressed: 1.1, 1.6, 2.1, 2.4, 3.1, 3.2, 3.3, 3.5

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Pathophysiology

The prostate continues to grow with age, potentially doubling in size between the ages of 21 and 50 and then almost doubling again between the ages of 50 and 80.8

In the prostate gland, type II 5-alphareductase converts circulating testosterone into dihydrotestosterone (DHT) – a potent androgen. DHT works locally, binds to androgen receptors in the cell nuclei: resu

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