Should We Investigate Prostatic Inflammation for the Management of Benign Prostatic Hyperplasia?

Abstract

Abstract Context Although benign prostatic hyperplasia (BPH) is the most frequent disease in elderly men, only a few predictive factors have been identified. Recently, prostatic inflammation has emerged as one of them. Objective This review describes the relationship between inflammation and BPH prognosis that emerges from the literature. Evidence acquisition Publications relating to the role of inflammation in BPH were identified by searching PubMed Medline database. Basic science and clinical studies were reviewed. Evidence synthesis At 12-wk gestation, few inflammatory cells can be observed in the prostatic gland. This amount progressively increases and is more frequent in surgery-derived specimens than in young normal prostates. In fact, almost 80% of surgery-derived specimens show signs of inflammation. Microscopic and immunohistochemical analysis of the inflammatory infiltrate has shown a vast majority of antigen-presenting cells; these immune cells could ensure the sterility of the genitourinary tract. However, immune cells are also releasing numerous cytokines and growth factors that recruit other cells that promote the growth of epithelial and stromal prostatic cells. This process finally results in prostate enlargement. Because of the relationship between BPH and inflammation, anti-inflammatory treatments have been tested in BPH and have been shown to improve urinary symptoms. They could therefore be proposed to treat BPH patients with prostatic inflammation. Although inflammation can be diagnosed on prostate biopsy, noninvasive biomarkers that could be used to monitor BPH treatment are still needed. Conclusions Chronic prostatic inflammation is a risk factor for prostate enlargement, BPH symptoms, or acute urinary retention. For BPH patients with inflammation, close surveillance and therapies that exert anti-inflammatory effects could therefore be proposed. However, reliable biomarkers have not yet been validated to detect prostatic inflammation in routine clinical practice.