Understanding the role of estrogen in the development of benign prostatic hyperplasia

Introduction: Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate that affects ageing men. As the number of men affected by this condition will only continue to grow with the aging population, finding new strategies and new therapeutic options for its treatment is crucial. Androgenic hormones have been known to play an important role in the development of BPH and they have been a target in its medical treatment. Estrogens have also been implicated in BPH but in contrast to androgens, the functions of estrogens in the prostate are still obscure. Objective: This review aims to highlight the roles of estrogen in the development of BPH. Methods: Authors reviewed the literature covering the past forty years to highlight the roles of estrogen in the prostate and BPH. Data from authors' experimental work in this field was also referenced. Results: The effects of estrogen in the prostate are mediated by estrogen receptors alpha and beta (ER alpha and ER beta). These two receptors have different expression and functions in the prostate, thereby presenting a window of opportunity to selectively target them for therapeutic purposes in BPH. The actions of estrogens, as mediated by estrogen receptors, appear to contribute to the development of BPH in men through an intricate molecular process that is yet to be fully elucidated. Although surgery remains the gold standard in the treatment of BPH, understanding the elusive role of estrogen in BPH, in addition to the established role of androgens, would enhance the current therapeutic options and perhaps lead to the development of new therapies. There are indications that phytoestrogens might be beneficial in the management of BPH. Conclusion: This review highlights the roles of estrogen as well as the therapeutic use of phytoestrogensin the prevention and management of BPH. (C) 2018 Pan African Urological Surgeons Association. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license