AUTHOR REPLY

Abstract

Several nonmalignant histological prostate findings have been shown to be of clinical relevance. For example, we and others have shown chronic histological prostate inflammation in needle biopsies is associated with worsening prostatitis- and benign prostate hyperplasia (BPH)-related symptoms over time. 1 Nickel JC Freedland SJ Castro-Santamaria R et al. Chronic prostate inflammation predicts symptom progression in patients with chronic prostatitis/chronic pelvic pain. J Urol. 2017 Jul; 198: 122-128 Google Scholar , 2 Nickel JC Roehrborn CG Castro-Santamaria R et al. Chronic prostate inflammation is associated with severity and progression of benign prostatic hyperplasia, lower urinary tract symptoms and risk of acute urinary retention. J Urol. 2016; 196: 1493-1498 Google Scholar While basal cell hyperplasia (BCH) in the transitional zone has been associated with BPH in prior studies, the clinical significance of BCH in needle biopsies of the peripheral zone has not been previously studied in earnest. 3 Netto GJ Epstein JI. Benign mimickers of prostate adenocarcinoma on needle biopsy and transurethral resection. Surg Pathol Clin. 2008; 1: 1-41 Google Scholar , 4 Henry G. Malewska A. Mauck R. et al. Molecular pathogenesis of human prostate basal cell hyperplasia. Prostate. 2017; 77: 1344-1355 Google Scholar Although limited by a low prevalence of BCH (1.3%), the current study is one of the largest analysis of BCH and it was unable to identify any association between BCH and prostate cancer, BPH or prostatitis-related symptoms. The lower BCH prevalence in our study likely stem from the fact that: (1) our biopsies targeted the peripheral zone only, and (2) subjects with very large prostates and/or severe urinary symptoms were excluded. Moreover, data from the 4-year repeat prostate biopsies were indeed analyzed but not included in the final manuscript given the results were similar to the ones obtained using 2-year biopsy data. While it is conceivable that future studies with larger BCH samples may identify correlations between BCH and clinically meaningful outcomes, the current relevance of BCH seems to rely solely on being a differential diagnosis for high-grade prostatic intraepithelial neoplasia and prostate adenocarcinoma and, as such, may be omitted from routine pathological prostate needle biopsy reports.