https://orcid.org/0000-0002-3503-7634
To the editor
We read with great interest the study “The association between histological prostatitis and benign prostatic hyperplasia: a single-center retrospective study” conducted by Li et al. [Citation1]. The authors retrospectively collected and analyzed the clinical data of 196 benign prostatic hyperplasia (BPH) patients, they concluded that patients with histological prostatitis (HP) have larger prostate volume (PV), more severe lower urinary tract symptoms (LUTS), and a higher risk of acute urinary retention (AUR). We congratulate the authors for their findings on the correlation between prostate inflammation and BPH development and progression. We would like to add our comments regarding this study, however, with the aim of better interpreting the results as well as improving future study designs.
First of all, readers should be noticed the patients in this study might be poorly representative. Only those who receive the surgical intervention (patients who have a symptomatic progression that is refractory to conservative measures or medical therapies) were included, accounting approximately for 10% of the BPH population. Furthermore, the overall AUR incidence was 59.7%, which was strikingly high. Therefore, the study cohort may not represent the general population, especially men with no or only mild symptoms of BPH.
Second, heterogeneity in the patients’ medication history was not evaluated. As the authors stated, the development and growth of the prostate are jointly regulated by sex hormones. In particular, 5α-reductase inhibitors have been deemed to reduce prostatic inflammation and induced the conversion of M1 macrophages to M2 macrophages in our previous study [Citation2]. Nevertheless, the role of non-steroidal anti-inflammatory drugs (NSAIDs) on BPH was confirmed, which might influence prostatic inflammation [Citation3]. We believe disclosure of the patients’ medication history is indispensable for the prostatic inflammation study.
In addition, the conclusion is worthy of discussion. It’s well documented that prostate-specific antigen (PSA) rises when AUR occurs, which implies the possibility of prostate microenvironment (i.e. histological prostatitis) could be impacted by AUR. The authors claimed BPH patients with HP have a higher risk of AUR. For a retrospective study without any interventions, we believe it might be inappropriate to draw a causality conclusion based on evidence from this study. Nonetheless, there was a correlation between prostate inflammation and AUR.
The authors presented an interesting study, however, well-designed prospective studies with large samples are needed for further understanding of this topic.
Respectfully, All authors
References
- Li J, Li Y, Cao D, et al. The association between histological prostatitis and benign prostatic hyperplasia: a single-center retrospective study. Aging Male. 2022;25(1):88–93.
- Wang XJ, Zhuo J, Luo GH, et al. Androgen deprivation accelerates the prostatic urethra wound healing after thulium laser resection of the prostate by promoting re-epithelialization and regulating the macrophage polarization. Prostate. 2017;77(7):708–717.
- Falahatkar S, Mokhtari G, Pourreza F, et al. Celecoxib for treatment of nocturia caused by benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled study. Urology. 2008;72(4):813–816.