Introduction: Current AUA guidelines suggest treatment with 5ARI for men with BPH and PSA > 1.5ng/ml. Phenotypic heterogeneity in benign prostatic hyperplasia (BPH) has been hypothesized to underlie variable response to medical therapy, but non-invasive clinical predictors of BPH cellular composition are lacking. In this study, we evaluated the stromo-glandular composition of BPH specimens for correlation with PSA density.
Methods: H&E stained sections from 132 untreated and 78 5ARI-treated BPH patients undergoing TURP or simple prostatectomy from 11/2015 to 11/2020 were scored for glandular content (Figure 1). Patients with missing PSA or prostate volume (PV) data were excluded. Univariate analysis was conducted to determine correlation of glandular content with PSA and PSA density. All analyses were performed using GraphPad Prism (v. 9.2.0).
Results: Prostate volume was positively correlated with PSA (P = 0.0002) and the percentage of glandular content was positively correlated with PSA (P = 0.0018) and PSA density (P = 0.0027) in 5ARI-naive men, but not in 5ARI-treated men.
Conclusions: There is strong correlation between histologic phenotype and PSA. In addition, PSA density may improve selection of patients for 5ARI medical therapy over PSA alone.