A 65-year-old man with benign prostatic hyperplasia has moderately severe symptoms and is started on finasteride. After six months of treatment with finasteride, his symptoms improve markedly and his prostate has regressed in size. Which of the following histological patterns was most likely present at the time of initiation of treatment?

Question

A 65-year-old man with benign prostatic hyperplasia has moderately severe symptoms and is started on finasteride.  After six months of treatment with finasteride, his symptoms improve markedly and his prostate has regressed in size.  Which of the following histological patterns was most likely present at the time of initiation of treatment?

Quizplus · Accepted Answer

Finasteride is a 5-alpha reductase inhibitor and it inhibits the conversion of testosterone to dihydrotestosterone. It acts on the epithelial components of the prostate gland and produces improvement of symptoms as well as reduction in the size of the gland. There are various histological patterns of BPH. Some patients have predominant epithelial hyperplasia and others have predominant stromal hyperplasia. Those with stromal hyperplasia may have collagen or smooth muscle predominance. Patients with epithelial predominance best respond to treatment with finasteride. (Choice B, C & D) Alpha-1 blockers produce symptomatic improvement in patients with BPH by their action on smooth muscles present in prostate and bladder base. Patients with smooth muscle predominance best respond to treatment with alpha-1 blockers. Patients with collagen predominance respond neither to finasteride nor to alpha-1 blockers. Educational objective: Finasteride acts on epithelium and alpha-1 blockers act on smooth muscles of prostate and bladder base.

A 65-Year-Old Man with Benign Prostatic Hyperplasia Has Moderately Severe