Asian Journal of Research and Reports in Urology

Relationship between the Neutrophil to Lymphocyte Ratio and International Prostate Symptoms Score in Men with a Benign Prostatic Enlargement

Muhd Zaki Azre Redzuan *

Urology Unit, Department of Surgery, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia.

Noor Azam Nasuha

Urology Unit, Department of Surgery, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia.

*Author to whom correspondence should be addressed.

---

Abstract

Introduction: The aim of this study was to investigate whether the neutrophil to lymphocyte ratio (NLR) can be used as a biomarker to evaluate the severity of urinary symptoms in patients with benign prostatic enlargement (BPE).

Methods: This study assessed NLR in a cohort of 357 patients with BPE attending to our outpatient clinic from May 2022 till May 2023. We also evaluated other relevant parameters including the International Prostate Symptom Score (IPSS), prostate specific antigen (PSA) level and the maximum urinary flow rate (Qmax). Correlations between NLR and, IPSS, PSA, prostate volume and Qmax were assessed statistically.

Results: The study's findings demonstrated that patients with high IPSS had significantly higher NLR with positive correlation (r=0.22, p<0.001). Similar relationship was seen between NLR and PSA (r=0.33, p<0.001). Positive correlations were also seen between NLR, and age (r=0.014, p=0.79) and prostate volume (r=0.134, p=0.01) but there were not statistically significant. Negative correlation between NLR and Qmax was seen (r= -0.146, p=0.006). The Receiver-Operating Characteristic (ROC) curve analyses showed that NLR of between 1.9 to 2.0 can be used as a parameter to differentiate severe and non-severe symptoms with sensitivity of 74% and specificity of 34% (p<0.001).

Conclusion: These findings justifies that NLR can be utilized as a biomarker, in combination with other parameters such as age, Qmax and PSA to accurately and more objectively evaluate the severity of lower urinary tract symptoms in patients with prostate conditions. Further studies required as its potential usage as a marker for monitoring and assessing BPE patients’ progression and response to treatment.

Keywords: Benign prostatic enlargement, neutrophil to lymphocyte ratio, international prostate symptoms score

---

---

---

References

Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia Prostate. 1990;17: 241-246.

Torkko KC, Wilson RS, Smith EE, Kusek JW, van Bokhoven A, Lucia MS. Prostate Biopsy Markers of Inflammation are Associated with Risk of Clinical Progression of Benign Prostatic Hyperplasia: Findings from the MTOPS Study. J Urol. 2015;194:454-61

Nickel JC, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS. The relationship between prostate inflammation and lower urinary tract symptoms: xamination of baseline data from the REDUCE trial. Eur Urol. 2008;54:1379. Erbay G, Ceyhun G. Association between hyperlipidemia and prostatic enlargement: A case-control study. Urologia Journal. 2022;89(1):58-63.

Yan H, Kuroiwa A, Tanaka H, Shindo M, Kiyonaga A, Nagayama A. Effect of moderate exercise on immune senescence in men. European Journal of Applied Physiology. 2001;86:105-111.

Elmusrati A, Wang J, Wang CY. Tumour microenvironment and immune evasion in head and neck squamous cell carcinoma. International Journal of Oral Science. International Immunopharmacology. 2021; 13(1);36:94-99.

Thapa D, Ghosh R. Chronic inflammatory mediators enhance prostate cancer development and progression. Biochemical Pharmacology. 2015;94(2):53-62.

Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, Li D. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: a retrospective cross‐sectional study. Journal of Medical Virology. 2020;92(11): 2573-2581.

Trtica Majnarić L, Guljaš S, Bosnić Z, Šerić V, Wittlinger T. Neutrophil-to-lymphocyte ratio as a cardiovascular risk marker may be less efficient in women than in men. Biomolecules. 2021;11(4):528.

De Nunzio C, Presicce F, Tubaro A. Inflammatory mediators in the development and progression of benign prostatic hyperplasia. Nature Reviews Urology. 2016;13(10):613-626.

Carruba G. Estrogen and prostate cancer: An eclipsed truth in an androgen‐dominated scenario. Journal of Cellular Biochemistry. 2007;102(4): 899–911.

Kim DS, Shin D, Lee MS, Kim HJ, Kim DY, Kim SM, Lee MG. Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis. The Journal of Dermatology. 2016;43(3): 305-310.

Abidi SH, Bilwani F, Ghias K, Abbas F. Viral etiology of prostate cancer: Genetic alterations and immune response. A literature review. International Journal of Surgery. 2018l52:136-140.

Emberton M, Cornel EB, Bassi PF, Fourcade RO, Gómez JM, Castro R. Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. International Journal of Clinical Practice. 2008;62(7):1076-86.