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An introduction to acinar pressures in BPH and prostate cancer

Nature Reviews Urology volume 10, pages 358–366 (2013)Cite this article

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Abstract

Intra-acinar and peri-acinar pressures in the prostate might be key factors in the evolution of its zonal morphology and the pathogenesis of BPH and cancer. Herein, I hypothesize that intra-acinar pressures lead to a decrease in apoptosis by distending or stretching acinar epithelium and its surrounding stroma. Increased prostatic smooth muscle content and tone might generate peri-acinar pressures, which could, in the long-term, counteract intra-acinar pressures and decrease epithelial stretch. Thus, it is proposed that BPH (characterized by increased prostatic smooth muscle and, therefore, raised peri-acinar pressures) might decrease the risk of prostate cancer progression by counteracting intra-acinar pressures. In the context of this theory, the transition zone might have evolved as a specialized region within the prostate that can mount a concerted stromal–epithelial response to increased urethral and intra-acinar pressures (BPH), and the urethral angulation, anterior stroma and the prostatic capsule have an adjunctive evolutionary role in this phenomenon.

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Figure 1: Anterior oblique view of the prostate and urethra.
Figure 2: Coronal section through the prostate and surrounding pelvic floor.
Figure 3: Acinar pressure and sperm aspiration.
Figure 4: The effects of BPH on stromal stretch.
Figure 5: The risk of advanced cancer decreases with distance from pelvic floor.

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Acknowledgements

The review that led to this article was inspired by the forceful queries about the nature of their disease raised by the patients with metastatic prostate cancer that I worked with in Los Angeles. This article is therefore dedicated to their memory, and to the memory of Dr John Stein. The views expressed in this article are my own and do not reflect the views of New York Presbyterian or Brooklyn Hospital personnel.

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    Panikar Wadhera

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Wadhera, P. An introduction to acinar pressures in BPH and prostate cancer. Nat Rev Urol 10, 358–366 (2013). https://doi.org/10.1038/nrurol.2013.86

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