Prostatic chronic inflammation is inversely associated with incidental prostate cancer after endoscopic surgery for benign prostatic obstruction

Objective To investigate the association between histological prostatic chronic inflammation (PCI) and incidental prostate cancer (iPCa) detected after endoscopic surgery for benign prostatic obstruction (BPO). Materials and methods: We retrospectively evaluated 404 consecutive patients who underwent transurethral resection of the prostate or holmium laser enucleation of the prostate between May 2021 and December 2024 for presumed BPO. Associations with iPCa were evaluated using conventional logistic regression including age group (<69 versus ≥69 years) and PCI, with Firth penalized logistic regression as a sensitivity analysis. Results iPCa was detected in 24 patients (5.9%), whereas PCI was identified in 118 specimens (29.2%). Most iPCa cases were International Society of Urological Pathology grade group 1 (22/24, 91.7%). PCI was present in 2 of 24 patients with iPCa (8.3%) and 116 of 380 patients without iPCa (30.5%). In the model including age group and PCI, PCI was inversely associated with iPCa (odds ratio [OR] 0.229, 95% confidence interval [CI] 0.053–0.996), while age ≥69 years was positively associated with iPCa (OR 3.404, 95% CI 1.239–9.351). The PCI estimate was attenuated in the Firth analysis (OR 0.279, 95% profile penalized-likelihood CI 0.055–0.890). Only two patients with PCI had iPCa. Conclusions PCI was less frequently identified in surgical specimens containing iPCa and showed an inverse association with iPCa after adjustment for age. The small number of events, limited adjustment for potential confounders, and possible differences in cancer detection preclude causal or clinical risk-stratification conclusions. These findings are hypothesis-generating.