Does prostate hyperplasia necessarily evolve into prostate cancer? The following facts illustrate this issue from several aspects.
From the epidemiological point of view, BPH and prostate cancer are both high in Iceland and European and American countries, while the incidence rate of Asian countries is relatively low. From the current report, countries with high incidence of BPH seem to have high incidence rate of prostate cancer, and vice versa. However, there are exceptions. The Middle East and Israel have a high incidence rate of BPH and a very low incidence rate of prostate cancer. This indicates that the development of prostate hyperplasia into prostate cancer is not a universal rule.
Anatomically, benign prostatic hyperplasia (BPH) occurs in the transitional zone of the prostate, while prostate cancer (PC) mostly occurs in the subcapsular gland of the peripheral region. Although the two coexist in the same gland, they are located in different locations.
From the perspective of ultrastructural studies, comparing prostate cancer cells with normal or proliferative prostate cells, there are certain mutations in prostate cancer cells, indicating a spectrum of ultrastructural changes to malignancy; The epithelial changes in benign prostatic hyperplasia have quantitative characteristics, and there is no malignant spectrum. This finding strongly supports the fact that prostate hyperplasia and prostate cancer are unrelated diseases.
Prostate cancer, known as incidental cancer of the prostate, can be found in 5-30% of surgical specimens of benign prostatic hyperplasia. Incidental cancer and prostatic hyperplasia are both located in the transitional zone of the prostate, and they seem to be closely related. However, up to now, the direct relationship between benign prostatic hyperplasia and incidental cancer has not been found, and there is no evidence that benign prostatic hyperplasia develops into prostate cancer, indicating the presence of prostate cancer.
Atypical hyperplasia can sometimes be found in surgical specimens of prostate hyperplasia. There are two commonly recognized types: intraepithelial tumors of the prostate and atypical adenomatous hyperplasia. The detection rate of intraepithelial tumors ranges from 20 to 72%, and varies with age. Recent decades of research have shown that both intraepithelial tumors and atypical adenomatous hyperplasia can develop into prostate cancer, but intraepithelial tumors and atypical adenomatous hyperplasia are different in nature from the prostate and are not derived from the prostate.
In summary, both prostate hyperplasia and prostate cancer are common cancers in elderly men. They coexist in a single gland and can develop under similar endocrine, genetic, or environmental conditions. Although they often occur simultaneously, they may not be related to each other. The argument about the malignant transformation of prostate hyperplasia has not yet been confirmed. If a patient with prostate hyperplasia has prostate cancer, it is essentially the simultaneous occurrence of both, rather than the development of prostate hyperplasia. This is why prostate cancer should be excluded from the diagnosis of benign prostatic hyperplasia.
(Intern Editor: Cai Junyi)