ABSTRACT

Benign prostatic hyperlasia (BPH) is a common condition in elderly male. Although the etiopathogenesis of BPH has not been clarified, recent evidence suggests a critical role of prostatic inflammation. Large cross-sectional and population based studies suggest a link between having a diagnosis of clinical prostatitis at earlier ages and the development of BPH in the elderly. Also, histologic prostate inflammation predicts the symptom severity in men with lower urinary tract symptoms (LUTS) associated with BPH. Those men with a chronic prostatic inflammation tend to have a higher International Prostate Symptom Score (IPSS) than who without. The severity of prostatic inflammation also show a significant association with the severity of LUTS. Both the presence and severity of inflammation can predict BPH progression defined as worsening of LUTS, acute urinary retention, and the necessity of surgery.

Evidence based data show that use of nonsteroidal antiinflammatory drugs may prevent or delay symptom progresssion, decreased urinary flow, and increase in serum PSA.

Although not cleary defined, the mechanism by which prostatic inflammation lead to development of BPH is likely to be associated with an age-dependent weakening of the immune system and a modified hormonal secretion, leading to deterioration of a population of suppressor cells that actively suppresses the recognition of prostatic antigens and an increase in proinflammatory cytokines such as IL-6, IL-8, and IL-15. Infiltration of the prostate by inflammatory cells and subsequent cascade of events leads to BPH.

The relationship between prostatic inflammation and BPH should be one of the main topics for basic and clinical research in urology.