Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia

Abstract

Purpose To review the role of a persistent prostatic inflammatory status (PIS) in the development and progression of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) and which medical therapies approved for LUTS/BPH may reduce persistent PIS. Methods Literature search in PubMed up to July 2019. Results The cause of histologically defined persistent PIS or chronic prostatic inflammation is multifactorial. It is evident in many men with LUTS/BPH, particularly in older men and in men with a large prostate volume or more severe (storage) LUTS. Additionally, persistent PIS is associated with an increased risk of acute urinary retention and symptom worsening. Of medical therapies approved for LUTS/BPH, the current evidence for a reduction of persistent PIS is greatest for the hexanic extract of Serenoa repens (HESr). This treatment relieves LUTS to the same extent as α1-adrenoceptor antagonists and short-term 5α-reductase inhibitors. Limited evidence is available on the effect of other mainstream LUTS/BPH treatments on persistent PIS. Conclusions Persistent PIS plays a central role in both the development and progression of LUTS/BPH. In men with LUTS/BPH who have a high chance of harbouring persistent PIS, HESr will not only improve LUTS, but also reduce (underlying) inflammation. Well-designed clinical studies, with a good level of evidence, are required to better evaluate the impact of BPH/LUTS medical therapies on persistent PIS.

Clinical Benefit of Tamsulosin and the Hexanic Extract of Serenoa Repens, in Combination or as Monotherapy, in Patients with Moderate/Severe LUTS-BPH: A Subset Analysis of the QUALIPROST Study

“…This would be the case, for instance, with a combination of TAM and HESr. The role of inflammation as a potential new target for medical therapy of LUTS/BPH has also highlighted the relevance of plant extracts, such as HESr, which have been shown to have an anti-inflammatory action [40].…”

Review of the Roles and Interaction of Androgen and Inflammation in Benign Prostatic Hyperplasia

“…The effect was similar to that of the classic BPH treatment drug finasteride. Interestingly, the researchers found that in addition to the antiandrogenic effect, saw palmetto also shows an anti-inflammatory effect, which can downregulate B lymphocyte infiltration in the prostate and reduce the levels of IL-1 and TNF-α [43,44]. At present, most scholars believe that pathogenic infection and lymphocyte aggregation caused by urine reflux are the main causes of prostatic inflammation, but clinically, BPH has not been observed to be associated with prostatitis.…”

Nonalcoholic fatty liver disease and risk of prostatic diseases: Roles of insulin resistance

“…Clinically, BPH results in bladder outlet obstruction, presenting as LUTS (Landau & Welliver, 2020). LUTS commonly define symptoms related to the storage and/or the voiding phase of micturition (De Nunzio et al., 2020). Most of the men developed LUTS may be due to the enlargement of the prostate gland when they grow older.…”