WHAT MAKES THE PROSTATE GROW?: WHERE GROWTH BEGINS: LOCATION, LOCATION, LOCATION

The prostate has five distinct zones. For this chapter, only one of these—the tiniest, an area known as the transition zone—is important. The transition zone makes up only about s percent of the normal prostate gland in young men. Yet this tiny ring of tissue is the source of all the trouble in BPH. It’s located right in the center of the prostate, and it makes a natural circle around the urethra. Several things happen here, which in combination produce BPH: Beginning at age 30 or 40, tissue in the transition zone begins to expand; bulbous, glandular nodules begin to spring up like mushrooms among the prostate cells lining the urethra. Over time, as this growth continues, the landscape of the transition zone changes dramatically. As they emerge, the nodules tend to form clusters, or lobes, at certain characteristic sites.

In BPH as in real estate, location of growth makes all the difference—the size of the prostate may have nothing to do with the degree of obstruction. For example, in lateral lobe enlargement, the tissue compresses the urethra from the sides. However, these lateral lobes can become quite large without producing much obstruction—during urination, they just swing open and shut like double doors in a saloon. In middle lobe enlargement, which is sometimes described as a “cork in a bottle,” the tissue acts as a moveable plug that can flip to block the bladder neck and cause major symptoms of urinary obstruction— even though the prostate may actually feel small from the outside.

Because these symptoms are the most urgent, men with middle lobe enlargement are much more likely to seek medical relief for BPH than, say, men with simple lateral lobe enlargement. What’s more common? Evidence from studies suggests that about 50 percent of men with BPH have middle lobe enlargement, 20 percent have growth in the lateral lobes, and 30 percent have both lateral and middle lobe enlargement.

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