Insights into the Relationships between Prostatic Disorders and Their Potential Impact on Future Urologic Practice

Although the relationship between increasing age and the prevalence of histologic benign prostatic hyperplasia (BPH), prostate inflammation, high-grade intraepithelial neoplasia, atypical small acinar proliferation, and prostate cancer has been understood for some time, our understanding of the interrelationships between prostate diseases beyond epidemiologic associations is evolving. Furthermore, we are just beginning to unravel how these relationships may affect ageing men, in terms of their effects on bladder function, resultant lower urinary tract symptoms, sexual dysfunction, and overall quality of life. There is increasing evidence of a role for inflammation in the development of prostate cancer and also in precipitating symptoms and acute urinary retention in men with BPH. Furthermore, experimental and clinical trial evidence demonstrates the importance of androgens, particularly dihydrotestosterone, in the development and maintenance of a number of prostate disorders. Although the theoretical role of the 5α-reductase inhibitors in the prevention of prostate cancer was hypothesised almost 20 yr ago, it was not until recently that the Prostate Cancer Prevention Trial demonstrated their benefit. Taken together with their effects on BPH, and putative benefits on chronic prostate inflammation, it is possible that the 5α-reductase inhibitors may have a broader role in the maintenance of prostate health and that they could provide concomitant benefits across a wider spectrum of prostate disease. Such a strategy has profound implications for the screening, detection, and long-term management of prostate disease in ageing men.