Role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting carcinoma prostate (CaP) in patients with lower urinary tract symptoms and raised serum prostate-specific antigen (sr.PSA)

Abstract

Background

Carcinoma prostate (CaP) is second most common cancer and sixth leading cause of cancer-related mortality among men worldwide. Prostate-specific antigen (sr. PSA) levels are prostate specific, not cancer specific. Therefore, finding non-invasive novel markers that can detect clinically significant CaP for preventing unnecessary biopsies is needed. Relation between host inflammatory responses and tumour has been increasingly recognized in various carcinomas. Many follow-up studies used neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with sr. PSA level for CaP detection in India. The present study explored the use of these biomarkers in predicting CaP in patients with lower urinary tract symptoms (LUTS).

Methods

This prospective observational analytical study included 220 patients who underwent prostate biopsy for LUTS and suspected CaP between 2019 and 2021. Pearson's correlation (r) was used to find association between various attributes. Receiver operating characteristic curve analysis was performed to determine cut-off values and find sensitivity, specificity, positive and negative predictive value of NLR and PLR. P-value <0.05 was considered statistically significant (α = 5%).

Results

Out of 263 patients, 43 were excluded. Among remaining 220 study patients, 166 had BPH and 54 CaP. Median values of NLR and PLR were significantly higher in CaP patients. There was a strong positive correlation noted between NLR, PLR, and CaP groups. Areas under receiver operating characteristic curve of NLR (p = 0.001) and PLR (p < 0.001) for predicting CaP were statistically significant, with cut-off values of >3.44 and > 165.96, respectively.

Conclusion

In present study, we found significant increase in NLR and PLR in CaP patients. These parameters could be useful as pre-prostate biopsy predictors of CaP and help avoid unnecessary biopsies.