Peripheral Blood Inflammatory Ratios and Prostate Volume in Benign Prostatic Hyperplasia: An Equivalence-Tested Cross-Sectional Study at a Tertiary Indonesian Referral Centre

Abstract

Background: Chronic inflammation contributes to benign prostatic hyperplasia (BPH), and complete blood count-derived ratios have been proposed as inexpensive surrogates of prostatic inflammatory burden.

Objective: To determine whether neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and lymphocyte-to-platelet ratio (LPR) are associated with ultrasonographically measured prostate volume in Indonesian men with BPH.

Methods: This cross-sectional study included 45 consecutive men with BPH at Dr. Mohammad Hoesin General Hospital, Palembang (March–June 2026). Spearman correlation and Mann–Whitney tests were complemented by pre-specified equivalence tests, Bayes factors, minimum-detectable-effect analysis and sensitivity analyses.

Results: Mean age was 70.31 ± 7.98 years and mean prostate volume was 58.14 ± 29.49 mL. NLR was elevated in 77.8% and MLR in 53.3%. Correlations with prostate volume were ρ = 0.055, 0.056 and 0.027 for NLR, MLR and LPR, respectively, each explaining <0.32% of variance. Equivalence held to |ρ| < 0.30 for NLR and LPR and to |ρ| < 0.35 for all three markers; Bayes factors favoured the null 5.0–5.2:1. Prostate volume did not differ across NLR or MLR categories.

Conclusion: Systemic inflammation was prevalent yet quantitatively unrelated to prostate volume. Blood-count ratios should not be used to estimate gland size or select an operative approach.