Impact of Inflammation on Progression of Clinical BPH

An examination of baseline prostate biopsies in a subgroup of 1,197 patients in the MTOPS study found that there was a chronic inflammatory infiltrate in 43% of the men [111]. It was hypothesized that the presence of histological inflammation may be a predictor of BPH progression. There was a clinically significant difference in the progression rate based on the presence or absence of inflammation. Patients in all groups (placebo, finasteride, doxazosin, and combination finasteride and doxazosin) with inflammation were more likely to progress clinically in terms of symptoms, AUR- or BPH-related surgery.

For those with no inflammation, there was overall clinical progression in 13.2% of patients, while 3.9% had BPH-related surgery and none had AUR; corresponding values for those who had chronic inflammation were 21, 7.3 (not significant), and 5.6%. Chronic inflammation accounted for every AUR event in this subgroup of patients with prostate biopsies, while in patients with no inflammation there was no AUR. The observation that the presence of prostatic inflammation may be clinically relevant in terms of prediction of BPH-related progression is very important. This observation was also confirmed by the 4-year longitudinal follow-up of the 8,000 men enrolled in the REDUCE trial [112-114]. Many of the enrolled men would have had BPH at baseline (predicted by high baseline mean IPSS scores, elevated PSA, and negative initial biopsy). The baseline histological status of these men is documented and the progression data in terms of BPH symptom and event (surgery and AUR) progression are to be collected. A further important point is that inflammation may also have an important role in the pathogenesis of prostate cancer [114] and that particular association will become very clear when the REDUCE trial is completed.

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