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.


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

How to Cite

Redzuan , M. Z. A., & Nasuha , N. A. (2023). Relationship between the Neutrophil to Lymphocyte Ratio and International Prostate Symptoms Score in Men with a Benign Prostatic Enlargement. Asian Journal of Research and Reports in Urology, 6(1), 46–53. Retrieved from


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