Role of Prostatic Inflammation in the Clinical Presentation of Benign Prostatic Hyperplasia

Abstract

ContextAlthough it was hypothesised >20 yr ago that prostatic inflammation could influence clinical presentation and possibly surgical outcome in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), only more recently has compelling substantiating evidence become available. ObjectiveTo review the evidence for the role of inflammation in the clinical presentation and treatment of BPH/LUTS. Evidence acquisitionThis article is based primarily on material presented at a satellite symposium entitled, “Inflammation and Prostatic Diseases: From Bench to Bedside,” held during the 2015 annual meeting of the European Association of Urology in Madrid, Spain. Current data regarding the link between inflammation and BPH were reviewed. Evidence synthesisStudies such as the large-scale Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial and others have clearly demonstrated the association between the presence and/or degree of histologic inflammation and its impact on parameters such as prostate volume, voiding LUTS, and type of surgery required to treat BPH. Prostatic inflammation has been shown to increase by threefold the risk for acute urinary retention, an end point in the natural progression of BPH. Inflammation has been proposed as the common thread between the metabolic syndrome and BPH/LUTS, which frequently co-exist, and offers new therapeutic targets for medical treatment. Motivated patients can undertake lifestyle modifications (eg, weight, diet, exercise) to potentially prevent the need for surgery. Selective cyclooxygenase-2 inhibition appears promising as a therapeutic approach for inflammation, but its suitability for long-term use in the BPH population is limited by safety concerns. ConclusionsGreater understanding of the relationship between inflammation and the clinical presentation of BPH/LUTS provides an opportunity to effect clinical changes to improve treatment outcomes. Patient summaryAn increased understanding of the role of prostatic inflammation in the pathogenesis, symptomatology, and progression of benign prostatic hyperplasia (BPH) is likely to change the treatment paradigm for BPH.