Improving Patient Selection for BPH Medical and Surgical Therapy Through a Deeper Understanding of Prostate Cellular and Molecular Biology.

This article explores how a deeper understanding of prostate cellular and molecular biology can improve treatment selection for benign prostatic hyperplasia (BPH). Current strategies rely on prostate size and symptoms, but BPH is highly heterogeneous in tissue composition. Recent research shows that identifying glandular versus stromal-dominant phenotypes using tools like prostate-specific antigen density, MRI, and ultrasound may predict treatment response. Personalized approaches based on these findings could improve outcomes and reduce side effects. The study advocates for a shift from symptom-based to phenotype-driven BPH management, paving the way for precision medicine in urology. BPH is an age-related enlargement of the prostate transition zone, which often results in progressive worsening of obstructive lower urinary tract symptoms (LUTS) and risk of acute urinary retention. By 2030, the US population aged more than 80 years is projected to double, with an estimated 11 million men affected by LUTS, mostly because of BPH. As the population ages and comorbidities worsen, BPH/LUTS patients will continue to outpace the availability of providers. Surgical management for BPH/LUTS has diversified dramatically over the last 10 years with a proliferation of minimally invasive surgical techniques (MISTs) designed to be performed under outpatient care and to minimize time to recovery. On the other hand, medical management has remained largely the same for decades. Current strategies for selecting the most appropriate intervention rely primarily on variables such as patient symptoms and interest as well as prostate volume and shape. Incorporating recent breakthroughs in our understanding of the cellular and molecular biology of BPH could alter the process of selecting the most appropriate treatment strategy.