Mechanical characterisation of the benign hyperplastic prostate

Introduction

Benign prostatic hyperplasia (BPH) is a condition that will affect most men as they age, with up to 25% requiring surgery. As a result, BPH is a significant area of interest in healthcare economics and its prevalence is likely to increase as our populations continue to age. Despite this, our understanding of the condition is still incomplete, and a major clinical challenge is identifying those that will need treatment. We sought to assess if the intrinsic mechanical properties of the prostate tissue could be used to help this clinical dilemma.

Methods and Results

Our systematic review of the literature identified a possible relationship with increasing prostate tissue stiffness and increasing lower urinary tract symptoms in patients with benign prostate hyperplasia. There is a wide variation in the testing methods and protocols used in the literature making direct comparison between papers difficult. We then proceeded to perform uniaxial tensile testing and histological analysis of prostate tissue removed from 22 men at surgery for BPH. Here we could identify that there is a relationship between mechanical properties for prostate tissue and the symptoms caused and that younger patients tended to have worse symptoms and stiffer prostates.

Finally, we sought to test if assessment of mechanical properties via a trans-urethral method would be possible. We proved the concept feasible through testing on 5 porcine prostates. We then further assessed the technique on 17 men undergoing prostatectomy. We again found that younger patients tended to have stiffer prostates; however, on this occasion, we did not identify a relationship with symptoms via this technique.

Conclusion

BPH is a prevalent disease in men with significant implications for healthcare spending. We have identified an under-studied area of BPH, have proven two methods of assessing prostate mechanical properties and have been able to relate these to patient symptoms and other parameters.