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

  • Cosimo De Nunzio
  • Andrea Salonia
  • Mauro Gacci
  • Vincenzo FicarraEmail author
Invited Review



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.


Literature search in PubMed up to July 2019.


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.


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.


Prostatic hyperplasia Prostatic inflammation Progression Medical therapy Phytotherapy Serenoa repens 



The authors are grateful to Ismar Healthcare NV who provided literature research and medical writing assistance; this was supported by an educational grant by Pierre Fabre Pharma Italy.

Author contributions

CN: critical review and editing of the manuscript. VF: critical review and editing of the manuscript. MG: critical review and editing of the manuscript. AS: critical review and editing of the manuscript.


This work was supported by an educational grant by Pierre Fabre Pharma Italy.

Compliance with ethical standards

Conflict of interest

C De Nunzio: consultant for Pierre-Fabre, Janssen and Astellas. V Ficarra: honoraria for speaking at symposia from Pierre Fabre and research grants from IDIPharma. M Gacci: company consultant, trial participation, fellowship, travel grant, receipt of grants/research supports for Astellas, Bayer, GSK, Ibsa, Konpharma, Lilly, Menarini, Pierre Fabre and Recordati. A Salonia: no conflict of interest.

Supplementary material

345_2020_3106_MOESM1_ESM.pdf (93 kb)
Supplementary file1 (PDF 93 kb)


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© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Urology, Sant’Andrea HospitalSapienza University of RomeRomeItaly
  2. 2.University Vita-Salute San RaffaeleMilanItaly
  3. 3.Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly
  4. 4.Minimally Invasive and Robotic Surgery, and Kidney TransplantationUniversity of Florence AOUC-Careggi HospitalFlorenceItaly
  5. 5.Department of Human and Pediatric Pathology “Gaetano Barresi”, Urologic SectionUniversity of MessinaMessinaItaly

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