Benign Prostatic Hypertrophy

Benign prostatic hypertrophy is extremely common in elderly men, seen essentially as a ‘normal’ part of aging, and is a major cause of outflow obstruction. By the age of 60, 50% of men have BPH, and by 80 years of age the prevalence has increased to 80%. It is due to a combination of stromal and glandular hypertrophy predominantly of the central zone (as opposed to prostate cancer which typically originates in the peripheral zone).
US
US has become the standard first line investigation after the urologist’s finger. Typically there is an increase in volume of the prostate with a calculated volume exceeding 30cc ( (A x B x C)/2 ). The central gland is enlarged, and is hypoechoic or of mixed echogenicity. Calcification can be seen both within the hypertrophied gland as well as in the pseudocapsule (representing compressed peripheral zone).
Post micturition residual volume is typically elevated.
MRI
Typically demonstrates the enlarged central zone to be heterogenous in signal with an intact low signal pseudocapsule around its periphery.
For more images from this case, and other cases of BPH please visit Radiopaedia.org here.
References
Primer of Diagnostic Imaging by Weissleder
J Ishida “Benign prostatic hyperplasia: value of MR imaging for determining histologic type” Radiology, Vol 190, 329-331
eMedicine
Credit: Dr Frank Gaillard
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