Peripheral Lymphocyte Count, Free/Total PSA Ratio, LUTS Predict The Severity of Prostatic Inammation in BPH Patients

Objective To study the correlation between peripheral blood lymphocytes, f/t PSA and LUTS symptoms, and prostatic inammation in BPH patients. Materials and Methods From May 2020 to October 2020, 120 patients (aged 56-85 years) with BPH undergoing elective transurethral resection of the prostate (TURP) were selected. Peripheral blood lymphocyte counts and f/t PSA values were measured preoperatively, and IPSS scores were assessed. Postoperative prostate tissues were sent for pathological examination, and the relationship between peripheral blood lymphocyte count, TPSA, f/t PSA values, relevant clinical laboratory parameters, and relevant LUTS symptoms and the distribution of prostate tissue inammation was analyzed. Results with the aggravation of prostatic inammation, IPSS score and TPSA value were lower, while f/t PSA value and lymphocyte count were lower. Multivariate logistic regression analysis of 120 BPH patients showed that age (> = 60) [odds ratio (OR) = 0.29, 95% CI = 0.31-2.10; P = 0.02], IPSS score [OR = 1.24, 95% CI = 1.13-1.37; P < 0.01], TPSA [OR = 1.10, 95% CI = 1.02-1.19; P = 0.02], f/t PSA [OR = 1.03, 95% CI = 0.01-0.15; P = 0.02], and lymphocytes [OR = 1.70, 95% CI = 0.78-3.77; P = 0.04] were related to the formation of prostatic inammation in BPH patients. Conclusion Peripheral blood lymphocyte count, TPSA, LUTS severity, and f/t PSA ratio can predict the severity of prostatic inammation, which may be used as diagnostic markers for BPH patients with LUTS who have prostatitis and of drug in BPH


Introduction
BPH is the most common chronic and slowly progressing urological disease in older men, reaching 80% in men aged 70 1 . In clinical practice, it may be associated with prostatic hypertrophy and benign prostatic obstruction, triggering bladder outlet obstruction and LUTS 2 . The pathogenesis and progression of BPH are still not fully understood, but they are likely to be multifactorial, and some studies have shown an association with increased sympathetic activity, hormonal changes, and metabolic syndrome 3 . Over the past few decades, BPH has been considered an immune-mediated in ammatory disease, and its persistent prostatitis state is a critical factor in the development and progression of BPH as a whole 4 .
Prostatic in ammation plays a crucial role in the pathogenesis and progression of TUTS secondary to BPH. LUTS can be de ned as symptoms related to the storage or voiding stage, and LUTS has an essential impact on the patient's quality of life. Numerous studies have shown that in ammation promotes the occurrence and development of LUTS symptoms in BPH patients, so it is important to nd relevant laboratory parameters to predict the severity of prostate tissue in ammation in BPH patients. This paper investigated the correlation between relevant laboratory parameters and the severity of in ammation in prostate tissue.

Patients information
We evaluated 120 male patients with BPH who underwent transurethral resection of the prostate (TURP) for LUTS from May 2020 to October 2020. This study was approved by the Medical Ethics Committee of the Second Hospital of Lanzhou University. All patients signed the surgical informed consent, and all relevant techniques and information collection were provided by the Department of Urology, the Second Hospital of Lanzhou University. All methods were performed in accordance with the relevant guidelines and regulations in the methods. Our assessments included IPSS score, blood PSA test, blood and urine routine.

Inclusion criteria
Postoperative pathological examination specimens suggest simple benign prostatic hyperplasia; postoperative pathological examination suggests benign prostatic hyperplasia with mild, moderate, and severe prostatic in ammation; no use of non-steroidal anti-in ammatory drugs, phosphodiesterase type 5 inhibitors, vitamins, and statins within one month before surgery.

Exclusion criteria
Any acute infection within one month before TURP; occasional prostate cancer; previous surgery for hematological malignancies; use of drugs that interfere with peripheral blood parameters within one month before surgery, including non-steroidal anti-in ammatory drugs, phosphodiesterase type 5 inhibitors, vitamins, and statins.

Case removal criteria
Misdiagnosis and misdiagnosis; serious postoperative complications; patients withdraw spontaneously.

Outcome measures
Evaluation of LUTS: Preoperatively using the IPSS score, the IPSS score was classi ed as "no symptom" (0), "mild symptom" (1-7), "moderate symptom" (8-19), and "severe symptom" (20-35); laboratory index f/t PSA ratio; peripheral blood lymphocyte count; severity of in ammation in the prostate tissue of the surgical specimen, the histological grade of in ammation in the prostate was classi ed as no prostatic in ammation, no in ammatory cells; mild prostatitis (grade I), scattered in ammatory cell in ltrates in the stroma; moderate prostatitis (grade II), non-con uent lymph nodes; and severe prostatic in ammation (grade III) according to the criteria recommended by the North American Cooperative Prostatitis Research Network (CPCRN) and the International Collaborative Prostatitis Network (IPCN).

Statistical Analysis
Statistical analysis was performed using IBM SPSS Statistics25.0; Enumeration data are expressed as a percentage, Data were expressed as mean ± stanstandard deviation for continuous variables and compared between groups using Student t-test or the Mann-Whitney U test as appropriate. The Pearson Chi-square test and Fisher exact test were used to comparing the categorical variables. For multivariate analysis, continuous variables, such as age, IPSS, were dichotomized with the median. When P < 0.05, there was a signi cant difference.
Results 120 patients (aged 56 to 85 years) were included, including those with in ammation in the prostate tissue (n = 84) and those without in ammation in the prostate tissue (n = 34). Comparison between the two groups: age (76.51 ± 13.21 vs 63.83 ± 9.35), IPSS score (19.21 ± 7.06 vs 27.97 ± 5.64), f/t PSA (0.29 ± 0.14 vs 0.19 ± 0.09), lymphocytes (1.58 ± 0.80 vs 1.26 ± 0.59) ( Table 1); after grouping according to prostate in ammation, with the severity of prostate in ammation, the main indicator of LUTS symptoms IPSS score (P < 0.05); on the other hand, the severity of prostate in ammation and f/t PSA ratio and lymphocyte values were negatively correlated (P < 0.05). Further Spearman correlation analysis revealed that lymphocytes and f/t PSA ratio were signi cantly associated with the severity of prostate in ammation (P < 0.05) ( Table 2) (Table 3).

Discussion
In the ZhangQ et al study 5 , the authors stated that prostate tissue in ammation was positively associated with LUTS symptoms. This suggests that early anti-infective therapy can relieve LUTS in BPH patients when they have prostatitis. A meta-analysis of randomized controlled trials concluded that nonsteroidal anti-in ammatory drugs improve LUTS and prostatic blood ow status 6 . Besides, higher grades of prostatic in ammation have also been found to predict inadequate response to α-adrenergic blockers and 5-α reductase inhibitors in BPH patients with LUTS. The study by Sugimoto M et al 7 stated that tadala l provided reasonable control of LUTS symptoms in BPH patients with prostatic in ammation.
Therefore, BPH patients with LUTS with prostatic in ammation may bene t from medical treatment, while BPH patients without prostatic in ammation may not. Prostatic in ammation and body mass index play an essential role in the development of BPH patients with LUTS 8, 9 . It is essential how to identify BPH patients with LUTS who have prostatic in ammation. However, it is a challenging clinical problem. Prostatitis can be empirically con rmed by pathology in patients undergoing a prostate biopsy, but most patients with BPH a icted with LUTS do not undergo prostate biopsy. It has been demonstrated that some systemic in ammatory response indicators C-reactive protein, soluble tumor necrosis factor-α receptor II, interleukins, neutrophil/lymphocyte ratio, and peripheral white blood cell count correlate with LUTS severity in BPH patients 10,11 . For measures such as interleukins, it is unlikely to be integrated into daily practice due to high costs. In our study, we found that peripheral lymphocyte counts were associated with prostatic in ammation. The ndings con rm those of previous work by Fujita K et al 12 ; this suggests that peripheral blood lymphocyte counts are related to the severity of LUTS symptoms of BPH.
Taken together, our ndings show that peripheral blood lymphocytes can predict prostate tissue in ammation severity in BPH patients to some extent. However, clinical urologists often judge BPH patients with prostatic in ammation based on clinical characteristics such as the severity of LUTS, response to drugs, prostate volume, and the presence of prostatic calci cation, which is often subjective and lacks objective evidence 13 . Our study stated that peripheral blood lymphocyte count and f/tPSA ratio were positively correlated with prostatic in ammation and LUTS symptom severity. In summary, peripheral blood lymphocyte count and f/tPSA ratio can effectively predict the severity of prostate tissue in ammation in BPH patients. However, the number of samples in this study is relatively small, so before clinical practice, multicenter and evidence-based testing is needed, and further validation is needed to determine its clinical utility.

Conclusion
Peripheral blood lymphocyte count, f/tPSA ratio combined with LUTS symptoms are able to predict prostate tissue in ammation to some extent.