Why and How to Evaluate Chronic Prostatic Inflammation

Context: In recent years, increasing scientific evidence has emerged to show that prostatic inflammation is one of the key predictive factors for benign prostatic hyperplasia (BPH). Objective: This review describes the recent literature regarding the relationship between prostatic inflammation and BPH, and focuses on the clinical perspective of why and how to evaluate prostatic inflammation. Evidence acquisition: Published literature relating to the role and evaluation of prostatic inflammation in BPH was identified by searching PubMed (Medline). Evidence synthesis: Laboratory and clinical studies have demonstrated that prostatic inflammation is a central and relevant mechanism in prostate enlargement and BPH development. Despite the potential clinical use of predictive biomarkers such as interleukin-8, monocyte chemotactic protein-1, chemokine (C-C motif) receptor 7, cytotoxic T lymphocyte-associated antigen 4, inducible T-cell costimulator, and CD40 ligand, biopsy remains the standard procedure for evaluating prostatic inflammation histologically; however, biopsy can only be performed in patients with suspected prostate cancer. In the absence of biopsy data, prostatic calcification and symptom severity can assist clinicians in diagnosing suspected prostatic inflammation. Prostatic calcification has been shown to be present in 86% of symptomatic male patients aged >50 yr. Clinical data have also demonstrated that chronic inflammation and International Prostate Symptom Score are statistically significantly correlated, with storage symptoms being particularly strongly correlated with chronic inflammatory status. Furthermore, as the presence of metabolic syndrome has been shown to be highly correlated with lower urinary tract symptoms (LUTS) due to BPH (LUTS/BPH), clinicians need to consider metabolic syndrome accompanying chronic prostatic inflammation when evaluating patients for LUTS/BPH. Conclusions: Chronic prostatic inflammation plays a central role in the pathogenesis and progression of BPH; therefore, it is important to evaluate it appropriately in patients with LUTS/BPH or suspected prostate cancer. (C) 2013 Published by Elsevier B.V. on behalf of European Association of Urology