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Benign Prostatic Hypertrophy
Bryan R. Foster, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Benign prostatic hyperplasia (BPH)
              • Synonyms

                • Benign prostatic hypertrophy 
              • Definitions

                • BPH: Enlarged prostate secondary to stromal, smooth muscle and glandular hyperplasia and associated with bladder outlet obstruction
                • Benign prostate enlargement (BPE): Enlarged prostate without clinical evidence of BPH

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. American College of Radiology: Prostate Imaging and Data System version 2.1. 2019. https://www.acr.org/-/media/ACR/Files/RADS/Pi-RADS/PIRADS-V2-1.pdf?la=en                                      
                                              2. Turkbey B et al: Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system Version 2. Eur Urol. 76(3):340-51, 2019
                                              3. Audouin M et al: Typology of intravesical prostatic protrusions, or so-called median lobes, in middle-aged and older men. Surg Radiol Anat. 40(4):389-93, 2018
                                              4. Foster HE et al: Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol. 200(3):612-9, 2018
                                              5. Guneyli S et al: Magnetic resonance imaging of benign prostatic hyperplasia. Diagn Interv Radiol. 22(3):215-9, 2016
                                              6. Kitzing YX et al: Benign conditions that mimic prostate carcinoma: MR imaging features with histopathologic correlation. Radiographics. 36(1):162-75, 2016
                                              7. Purysko AS et al: PI-RADS version 2: a pictorial update. Radiographics. 36(5):1354-72, 2016
                                              8. Vuichoud C et al: Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 22 Suppl 1:1-6, 2015
                                              9. Rosenkrantz AB et al: Radiologist, be aware: ten pitfalls that confound the interpretation of multiparametric prostate MRI. AJR Am J Roentgenol. 202(1):109-20, 2014
                                              10. Chesnais AL et al: Differentiation of transitional zone prostate cancer from benign hyperplasia nodules: evaluation of discriminant criteria at multiparametric MRI. Clin Radiol. 68(6):e323-30, 2013
                                              11. Hoeks CM et al: Transition zone prostate cancer: detection and localization with 3-T multiparametric MR imaging. Radiology. 266(1):207-17, 2013
                                              12. Jung SI et al: Transition zone prostate cancer: incremental value of diffusion-weighted endorectal MR imaging in tumor detection and assessment of aggressiveness. Radiology. 269(2):493-503, 2013
                                              13. Mitterberger M et al: Ultrasound of the prostate. Cancer Imaging. 10:40-8, 2010
                                              14. Oto A et al: Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology. 257(3):715-23, 2010
                                              15. Loeb S et al: Prostate volume changes over time: results from the Baltimore Longitudinal Study of Aging. J Urol. 182(4):1458-62, 2009
                                              16. Kanao K et al: Three-dimensional ultrasonography in evaluation of benign prostatic hyperplasia. Int J Urol. 11(12):1087-91, 2004
                                              17. Tubaro A et al: Investigation of benign prostatic hyperplasia. Curr Opin Urol. 13(1):17-22, 2003
                                              18. Grossfeld GD et al: Benign prostatic hyperplasia: clinical overview and value of diagnostic imaging. Radiol Clin North Am. 38(1):31-47, 2000
                                              19. Aarnink RG et al: Aspects of imaging in the assessment and follow up of benign prostatic hyperplasia. Curr Opin Urol. 9(1):21-9, 1999
                                              20. Ishida J et al: Benign prostatic hyperplasia: value of MR imaging for determining histologic type. Radiology. 190(2):329-31, 1994
                                              21. Arrighi HM et al: Natural history of benign prostatic hyperplasia and risk of prostatectomy. The Baltimore longitudinal study of aging. Urology. 38(1 Suppl):4-8, 1991
                                              22. Schiebler ML et al: Prostatic carcinoma and benign prostatic hyperplasia: correlation of high-resolution MR and histopathologic findings. Radiology. 172(1):131-7, 1989
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Benign prostatic hyperplasia (BPH)
                                                          • Synonyms

                                                            • Benign prostatic hypertrophy 
                                                          • Definitions

                                                            • BPH: Enlarged prostate secondary to stromal, smooth muscle and glandular hyperplasia and associated with bladder outlet obstruction
                                                            • Benign prostate enlargement (BPE): Enlarged prostate without clinical evidence of BPH

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. American College of Radiology: Prostate Imaging and Data System version 2.1. 2019. https://www.acr.org/-/media/ACR/Files/RADS/Pi-RADS/PIRADS-V2-1.pdf?la=en                                      
                                                                                          2. Turkbey B et al: Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system Version 2. Eur Urol. 76(3):340-51, 2019
                                                                                          3. Audouin M et al: Typology of intravesical prostatic protrusions, or so-called median lobes, in middle-aged and older men. Surg Radiol Anat. 40(4):389-93, 2018
                                                                                          4. Foster HE et al: Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol. 200(3):612-9, 2018
                                                                                          5. Guneyli S et al: Magnetic resonance imaging of benign prostatic hyperplasia. Diagn Interv Radiol. 22(3):215-9, 2016
                                                                                          6. Kitzing YX et al: Benign conditions that mimic prostate carcinoma: MR imaging features with histopathologic correlation. Radiographics. 36(1):162-75, 2016
                                                                                          7. Purysko AS et al: PI-RADS version 2: a pictorial update. Radiographics. 36(5):1354-72, 2016
                                                                                          8. Vuichoud C et al: Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 22 Suppl 1:1-6, 2015
                                                                                          9. Rosenkrantz AB et al: Radiologist, be aware: ten pitfalls that confound the interpretation of multiparametric prostate MRI. AJR Am J Roentgenol. 202(1):109-20, 2014
                                                                                          10. Chesnais AL et al: Differentiation of transitional zone prostate cancer from benign hyperplasia nodules: evaluation of discriminant criteria at multiparametric MRI. Clin Radiol. 68(6):e323-30, 2013
                                                                                          11. Hoeks CM et al: Transition zone prostate cancer: detection and localization with 3-T multiparametric MR imaging. Radiology. 266(1):207-17, 2013
                                                                                          12. Jung SI et al: Transition zone prostate cancer: incremental value of diffusion-weighted endorectal MR imaging in tumor detection and assessment of aggressiveness. Radiology. 269(2):493-503, 2013
                                                                                          13. Mitterberger M et al: Ultrasound of the prostate. Cancer Imaging. 10:40-8, 2010
                                                                                          14. Oto A et al: Prostate cancer: differentiation of central gland cancer from benign prostatic hyperplasia by using diffusion-weighted and dynamic contrast-enhanced MR imaging. Radiology. 257(3):715-23, 2010
                                                                                          15. Loeb S et al: Prostate volume changes over time: results from the Baltimore Longitudinal Study of Aging. J Urol. 182(4):1458-62, 2009
                                                                                          16. Kanao K et al: Three-dimensional ultrasonography in evaluation of benign prostatic hyperplasia. Int J Urol. 11(12):1087-91, 2004
                                                                                          17. Tubaro A et al: Investigation of benign prostatic hyperplasia. Curr Opin Urol. 13(1):17-22, 2003
                                                                                          18. Grossfeld GD et al: Benign prostatic hyperplasia: clinical overview and value of diagnostic imaging. Radiol Clin North Am. 38(1):31-47, 2000
                                                                                          19. Aarnink RG et al: Aspects of imaging in the assessment and follow up of benign prostatic hyperplasia. Curr Opin Urol. 9(1):21-9, 1999
                                                                                          20. Ishida J et al: Benign prostatic hyperplasia: value of MR imaging for determining histologic type. Radiology. 190(2):329-31, 1994
                                                                                          21. Arrighi HM et al: Natural history of benign prostatic hyperplasia and risk of prostatectomy. The Baltimore longitudinal study of aging. Urology. 38(1 Suppl):4-8, 1991
                                                                                          22. Schiebler ML et al: Prostatic carcinoma and benign prostatic hyperplasia: correlation of high-resolution MR and histopathologic findings. Radiology. 172(1):131-7, 1989