Co esponding au ho : Ugwuene F ancis O.
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Benign p os a e hype plasia p e alence: Enugu s a e o Nige ia: A case s udy
Ugwuene F ancis O 1, *, So onnadi Cla a N 2 and Asogwa Benne h E 3
1 Depa men o Medical Labo a o y Science, Facul y o Allied Heal h Sciences, Enugu S a e Uni e si y o Science and
Technology (ESUT); Enugu, Nige ia.
2 Depa men o Physiology, Facul y o Basic Medical Sciences, ESUT; Chemical Pa hology Enugu, Nige ia.
3 Chemical Pa hology Depa men , Esu Teaching Hospi al, Enugu, Nige ia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2281-2285
Publica ion his o y: Recei ed on 30 Ma ch 2025; e ised on 09 May 2025; accep ed on 11 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1578
Abs ac
The p e alence o BPH a ies om ace o ace, ibe o ibe and om coun y o coun y. I became necessa y o know
he BPH p e alence in Enugu S a e o Nige ia ollowing he ising cases o BPH, P os a i is and P os a e cance in Nige ia.
A o al o 237 adul men a he age ange o 40 o 80 yea s we e es ed o PSA, using he p inciple o immunological
an ibody an igen eac ion. I was s a is ically no ed ha he PSA o men be ween he ages o 40 o 49 yea s ell wi hin
no mal physiological e e ence ange. PSA o men wi hin 40 o 60 yea s showed signi ican inc ease(P<0.05) while ha
o men wi hin 61 o 80 yea s had signi ican inc ease o PSA (p<0.05). This wo k concludes ha he e is a p e alence o
bo h his ological enla gemen o p os a e and clinical BPH in Enugu s a e o Nige ia.
Keywo ds: P e alence; P os a e; BPH; PSA
1. In oduc ion
Benign P os a e Hype plasia (BPH) also known as Benign P os a e Hype ophy is a condi ion in men in which he
p os a e gland is enla ged and no cance ous. On he o he hand, i is a mul i ocal, non-malignan hype plas ic, and
p og essi e his opa hological change in s omal and epi helial cells in he ansi ional zone o he p os a e gland,
esul ing in disc e e p os a ic nodules, in lamma ion, ib osis and changes in smoo h muscle ac i i y, which can cause
pa ial o comple e obs uc ion o he u e h a (1,2).
The p os a e gland is an exoc ine gland ha lies in he pel ic ca i y be ween he u ina y bladde and he base o he
penis. I also lies in on o he ec um (3). I is abou he size o a walnu wi h he weigh o abou 8g in male you h bu
p og essi ely hype ophies wi h age and could weigh 40g by he age o 50 yea s. The p os a e is di ided in o wo lobes,
he igh and he le lobes. The uppe pa o he p os a e is called he base and i es s agains he lowe pa o he
bladde , while he lowe pa is called he apex. The p os a e is made up o many b anching duc s su ounding he
s oma. The cells ha line he p os a e duc s make p os a e luid which is mixed wi h he spe m and o he luids o make
alkaline semen (4). The alkalini y and enzyme con en o he p os a e luid helps o hicken he semen, inc ease he
mo ili y and li e span o he spe m cells in he agina. The sodium, chlo ide, po assium, calcium, magnesium, zinc,
p o eins, ci a e and suga s among some an igens and enzymes such as P os a e Speci ic An igens (PSA) help o
main ain he po ency o he spe m cells. The PSA and ACP a e o en used along wi h adionic scans/ul asound, and
Compu e The mog aphy (CT) scan as diagnos ic ools o he in es iga ion and managemen o p os a e diso de s
including BPH (4,5).
Sonog aphically, he e a e abou eigh ypes o BPH, namely: Type O, shows an equal o less han 25cm3 p os a e
showing li le o no zonal enla gemen . Type one shows bila e al ansi ion zone (TZ) enla gemen . Type wo shows
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2281-2285
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e o u e h al enla gemen , Type h ee shows bila e al TZ and e o u e h al enla gemen while Type ou is
peduncula ed enla gemen . Type i e shows peduncula ed enla gemen wi h bila e al TZ and o e o u e h al
enla gemen , while ype six is seen wi h sub igonal o ec opic enla gemen . Type se en shows o he combina ions o
enla gemen (6).
The p os a e is basically o ou zones; an e io ib omuscula s oma, cen al zone, pe iphe al zone and ansi ion zone.
The ansi ion zone is a ballon-shaped componen o he p os a e ha is loca ed in he pe iu e h al egion. Mos
p os a ic adenoca cinomas de elop in he pe iphe al zone, al hough some a ise in he ansi ion zone. The ansi ion
zone is he exclusi e si e o benign p os a ic hype plasia. Bo h adenoca cinoma and BPH a ec ing he ansi ion zone
may cause u ina y obs uc ion. Ca cinomas ha de elop in he ansi ion zone a e gene ally well di e en ia e (6,7,8,9).
When a man eaches he age o 40 yea s and especially on he mid 40s, he a ea o he p os a e gland ha enci cles he
u e h a especially he a ea o he ansi ional zone, begins o g ow beyond he no mal size. The p os a e g ow h a his
s age is mo e dependen on he ho monal sec e ion o he es es known as he and ogens, especially he es os e one.
The es os e one is con e ed o dihyd o es os e one by he ca aly ic ac i i y o 5 - educ ase (10,11).
The hype plasia o p os a e gland ha is mainly associa ed wi h age is a non-cance ous inc ease in size o he p os a e
(12).
Apa om age, gene ics and ho mones, o he ac o s such as me abolic synd ome ( ype 2 diabe es, and low le el o
high-densi y lipop o ein in ake), ecu en bac e ial in ec ion and ecu en ac i a ion o g ow h ac o s, a e associa ed
wi h de elopmen o BPH ises ma kedly wi h inc eased in age (13,14).
The age speci ic p e alence o benign p os a e hype plasia (BPH) has been es ima ed om au opsy s udies o be 8% in
ou h decades o li e, 50% in he six decades o li e, and 80% in he nin h decades o li e (15). The e is ye no clea
pa e n o p e alence o BPH due o ace, as a iable esul s ha e been p oduced in obse a ional s udies compa ing
black, Asian and whi e men (15). The e is a gene ic componen o BPH p e alence. A case con ol analysis in which men
below 64 yea s unde wen su ge y o BPH no ed ha male ela i es, espec i ely and b o he s had 4- old and 6- old
same age ange isks o BPH su ge y (16). I was equally obse ed ha abou 50% men below 60 yea s unde going
su ge y o BPH has a he i able o m o he disease and o he indings sugges an au osomal dominance pa e n o
inhe i ance (17). The e we e indica ions ha modi iable li es yle ac o s and mac o and mic onu ien s may
subs an ially in luence he na u al his o y o BPH. Mac o nu ien s, inc eased o al ene gy in- ake, ene gy-adjus ed o al
p o ein in- ake, ed mea , a , milk and- dai y p oduc s, ce eals, b ead, poul y and s a ch, all po en ially inc ease he
isks o clinical BPH and BPH su ge y, while ege ables, ui s, polyunsa u a ed a y acids, linoleic acid and i amin D,
po en ially dec ease he isk o BPH. Also, highe ci cula ing concen a ion o Vi amin E, lycopenes, selenium and
ca o ene ha e been in e sely associa ed wi h BPH (15).
Physical ac i i y is ano he ac o ha is associa ed o BPH p e alence. A me a-analysis o some published wo k indica e
ha mode a e o igo ous physical ac i i y educed he isk o BPH by as much as 25% ela i e o seden a y li es yle
(18,19). Me abolic synd omes such as diabe es, dis up ion o glucose homeos asis and obesi y ha e been linked o
inc eased p os a e size and olume and p e alence o BPH and BPH su ge y (15) In lamma o y condi ions b ough
abou by in lamma o y cy okines om adipose issues is associa ed wi h inc eased isk o p e alence o BPH (15). The e
is also o e whelming e idence o suppo ha e ec ile dys unc ion and lowe u e h al ac diseases may be
con ibu ing o p e alence o BPH [20].
Wo ldwide p e alence o BPH a ies om 20-62% in men o e 50 yea s and his includes USA, UK, Japan. While epo s
om Ghana and Sou h A ica ha e BPH p e alence o 20-62% in men o e 50 yea s and 50% in adul males o 60 yea s
espec i ely (15). In Eki i S a e o Nige ia (Wes e n Nige ia), he p e alence a e is be ween 104 pe 1000 and o men
a i h and se en h decade o li e and 429 pe 1000 be ween eigh h o nin h decades o li e and abo e (21). This wo k
cen e ed mo e on de e mining he BPH p e alence o men be ween 4 h o 5 h decades o li e, 6 h o 7 decades o li e
and 8 and abo e decades o li e in Enugu S a e using p os a e speci ic an igen as diagnos ic index.
2. Ma e ials and me hods
This esea ch wo k was ca ied ou in Enugu me opolis o Enugu s a e o Nige ia. A o al o 237 adul men a he age
ange o o y (40) o eigh y (80) yea s we e used in he s udy. The subjec s we e g ouped in o h ee, and blood samples
we e collec ed espec i ely and hei p os a e speci ic an igen es s done using he p inciple o immunological an ibody-
an igen eac ion.
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G oup 1 was made up o 36 men a he age ange o o y (40) o o y-nine (49), g oup 2 was made up o 117 men a
he age ange o i y (50) o six y (60) yea s while g oup 3 was made up o 84 men a he age ange o six y one (61) o
eigh y (80) yea s. The mean and s anda d de ia ion o each g oup we e ob ained om hei espec i e aw da a and
ep esen ed as shown below.
The PSA es was based on he p inciple o immunological an ibody-an igen eac ion. The eac ion o he p os a e
speci ic an igen (PSA) in he conjuga es in he sys em p oduces pinkish pu ple wi h he inco po a ed ch omogen. The
colo concen a ion is di ec ly p opo ional o he concen a ion o he p os a e speci ic an igen in he se um semen
espec i ely (20).
Consen was ob ained om each o he 237 men used o his s udy. Da a analysis was done by he use o s uden s - es
s a is ical me hod.
3. Resul
Table 1 PSA le els o h ee age g oups o men in Enugu me opolis o Nige ia
PSA
GROUP 1
AGES 40-49 YRS
GROUP 2
AGES 50-60 YRS
GROUP 3
AGES 61-80
N = 36
N = 117
N = 84
PSA mg/ml
(Mean + SD
3.3 + 1.8
6.5 + 3.3
9.0 + 1.36
Table 1 shows he p og ession o inc ease o PSA le els om he a e age ages o 40 – 49, 50 – 60 and 61 – 80.
Table 2 S a is ical compa ison o deg ee o signi icance o PSA le els o g oup 1 and g oup 2
PSA
GROUP 1
AGES 40-49 YRS
GROUP 2
AGES 50-60 YRS
- Tes
N = 36
N = 117
PSA mg/ml
(Mean + SD
3.3 + 1.8
6.5 + 3.3
P < 0.05
Table 2 shows ha he e was signi ican inc ease in PSA le els o men wi hin he ages o 50 – 60 yea s when compa ed
wi h hose o 40 – 49 yea s.
Table 3 S a is ical compa ison o deg ee o signi icance o PSA le els o g oup 2 and g oup 3
PSA
GROUP 2
AGES 50-60 YRS
GROUP 3
AGES 61-80 YRS
- Tes
N = 117
PSA mg/ml
(Mean + SD
6.5 + 3.3
9.0 + 1.3
P < 0.05
Table 3 shows ha he e was signi ican inc ease in he PSA le els o men wi hin he ages o 61 – 80 yea s when
compa ed wi h hose o 50 – 60 yea s.
4. Discussion
This s udy o benign p os a ic hype plasia p e alence in Enugu S a e o Nige ia cen e ed mo e on e alua ing he BPH
p e alence o men be ween o h o i h decades o li e, six h o se en h decades o li e and eigh h and abo e decades
o li e. This was done h ough he biochemical es ima ion o he o al PSA o he abo e w i en g oups o men in Enugu
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2281-2285
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s a e o Nige ia. The P os a e Speci ic An igen (PSA) s a us o he h ee g oups we e compa ed agains he known
esea ch es ablished no mal physiological e e ence ange o < 4.0 ng/ml. In his Enugu Me opolis esea ch wo k, he
mean and s anda d de ia ion o g oup 1 (40 – 49) yea s men se e also as a no mal e e ence con ol o g oup 2 and 3
men.
The esul s o he PSA es ima ion among he h ee age ange g oups o men showed ha s a is ically he PSA le els o
he i s g oup o men (40-49 yea s) ell wi hin he s anda d physiological no mal e e ence ange o PSA o men.
Howe e , he PSA o a ew men in he aw da a o ha g oup showed a ma ginally aised PSA, indica ing ha he no mal
physiological e e ence ange o PSA le els o men be ween 40 o 49 yea s is no absolu e.
The PSA esul s o g oup 2 men (50 - 60) yea s showed a signi ican inc ease when compa ed wi h g oup 1 men (P<
0.05). This inding ag ees wi h some pas esea ch indings which s a ed ha bo h his ological enla gemen o p os a e
and clinical BPH ha e been obse ed in men wi hin he ages o 50 o 60 yea s (21,22,23).
The PSA esul s o g oup 3 men (61-80 yea s) showed a signi ican ly aised alue when compa ed wi h he g oup 2 men
(P<0.05). This is also in consonance wi h Ojowola, e al 2017 (18) which s a ed ha be ween 5 h o 9 h decades o li e
he e was a p e alence o BPH in Eki i S a e o Nige ia. Gene ally, he molecula e iology o BPH has been obse ed
h ough complica ed and poo ly unde s ood p ocesses, ye se e al isk ac o s o i s de elopmen ha e been iden i ied
o include age, gene ics ( amily his o y), obesi y, ype 2 diabe es melli us, ho mones, g ow h ac o s, in lamma ion and
li e s yle ac o s such as poo exe cise (22,23,). Du ing his esea ch wo k, i was obse ed ha a good pe cen age o
men wi hin he age o 50 o 60 yea s wi h aised PSA le els had no clinical symp oms o BPH.
5. Conclusion
This wo k he e o e concludes ha he e was a p e alence o bo h his ological enla gemen o p os a e gland and
clinical BPH in Enugu S a e o Nige ia wi hin he ages o 50 o 80 yea s o men.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es .
The e was no con lic o in e es .
S a emen o in o med consen
Consen was ob ained om all indi idual pa icipan s used in he s udy.
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