Miller, Paul David; (1993) Biomorphometric studies in benign prostatic hyperplasia. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The ageing population structure, with concomitant increase in the prevalence of the pathologies of age and the morbidity associated with prostatectomy, require that we look to alternative forms of treatment for benign prostatic hyperplasia (BPH). Although prostatic growth is dependent on androgens, especially dihydrotestosterone, the effect of steroids is probably mediated by other regulators. Androgens and oestrogens are believed to provide the hormonal environment that is essential for other biochemical factors to induce hyperplasia and perhaps malignancy. The aim of this study was to investigate one of the newly discovered relevant biochemical "factors" (epidermal growth factor). This growth factor is found in high concentrations in prostatic fluid and its relationship with the hormonal environment, steroid receptors and the presence of prostatic pathology have been examined. Benign prostatic hyperplasia and carcinoma are known to occur predominantly in two different regions of the gland. Variations in growth factor binding and steroid receptors within the gland have therefore been studied, as well as differences between patient groups. Use of new computerised morphometric techniques allowed the measurement, and more accurate comparison of the amounts of stromal and glandular tissue in different samples of prostatic tissue. These were correlated with the biochemical data from the same samples. The results show increased epidermal growth factor binding in BPH and a close association between steroid receptors and growth factor receptors in the abnormal part of the prostate. Although this suggests up regulation of the growth factor receptors in BPH, receptor binding is also found to be closely related to tissue morphometry. These findings should help understanding of growth regulation in the prostate and the pathogenesis of BPH. Ultimately it is hoped that this will also help identify those groups of patients who will respond to pharmacological treatment as opposed to those who will require prostatectomy for relief of their symptoms.

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