BPH and CP/CPPS
Frequently confused, BPH and CP/CPPS are two quite separate entities.
Some have speculated that the prostatic inflammation commonly found in BPH is the equivalent of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) or that it has an infectious etiology. The comparison between CP/CPPS and BPH is becoming increasingly incongruous with the publication of recent studies that find chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) not associated with inflammation at all (and therefore not associated with the strict meaning of the term "prostatitis"), or perhaps associated with an inflammation in a different part of the gland (deeper layers).
Other big differences people must account for are:
- Men with BPH are usually in their latter years, whereas men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have an average age of around 30.
- CPPS can be disabling in its pain intensity, whereas BPH symptoms are more usually described as "irritating".
- CPPS is not cured by procedures which alleviate BPH.
- Difficulty urinating comes and goes (waxes and wanes) with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and can often be helped by chemicals like quercetin. This is not the case in BPH.
So where does the inflammation in BPH come from? A possible etiology was posited in Acta Histochem 1998 Nov;100(4):439-49, Characterisation of inflammatory cells in benign prostatic hyperplasia. Anim, Udo et al
"....PSA and PSAP activity was lost in recently damaged prostatic glandular epithelium and reappeared only in regenerating secretory epithelium, indicating leakage as a result of damage. We suggest that the initial response to prostatic injury is cellular, and probably related to leakage into the periglandular tissues of PSA, PSAP and other antigenic molecules normally present in prostatic secretion. Macrophages respond, followed by recruitment of T-lymphocytes which participate in the inflammatory response and accumulate around the damaged glands."
The idea here is that the endocrine-driven swelling/growth of the aged prostate causes fine ducts to rupture, exposing the inner layers of the prostate to "PSA, PSAP and other antigenic molecules normally present in prostatic secretion", thus causing inflammation. This has nothing to do with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) as far as we know.