Don't overlook impact of inflammation on BPH

The research, conducted by Claus Roehrborn, MD, looked at a large subset of men who participated in the Medical Therapy of Prostatic Symptoms (MTOPS) study, a landmark 5-year trial comparing BPH treatment with an alpha-blocker, 5-alpha-reductase inhibitor, a combination of these two drugs, and placebo. The current analysis found that men with BPH and acute or chronic prostate inflammation are significantly more likely to progress clinically than those without inflammation. In particular, the risk of acute urinary retention was significantly higher in placebo patients with inflammation.

Men with prostate inflammation tended to have larger glands and higher PSA values as well.

The inflammatory process often leads to hypertrophy of cells and swelling of glands, and in the prostate, this would naturally lead to the obstruction of urine flow. It stands to reason that if this process is ameliorated with effective treatment, then BPH patients with the added finding of inflammation will benefit.

The data may also suggest a new way of thinking about the management of BPH. If Dr. Roehrborn's work can be substantiated, then diagnosis and treatment of inflammation in select men should be considered. Although many urologists are reluctant to examine express prostatic secretion, this is a simple, time-honored method to test for an increase in white cells, a reliable marker of inflammation. In light of the current research findings, examining the EPS appears to be especially important in BPH patients with long-standing symptoms that do not respond to treatment with an alpha-blocker or 5-alpha-reductase inhibitor.

In those patients who do have elevated white cell counts, anti-inflammatory drugs, either alone or in combination with an alpha-blocker or 5-alpha-reductase inhibitor, may have an important role in treating or possibly even preventing the progression of BPH.

Anthony J. Schaeffer, MD , a member of the Urology Times editorial council, is professor and chairman of urology at Northwestern University Medical School, Chicago.