The gut-prostate axis in benign prostatic diseases: Mechanistic pathways and therapeutic implications

Benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are common benign prostatic diseases in middle-aged and older men. The prevalence of BPH increases with age, affecting approximately 45% of men older than 45 years and nearly 80% of those older than 70 years. CP/CPPS predominantly affects men aged 30-50 years, with a global prevalence of approximately 8%. Conventional pathogenic models emphasize androgen metabolism, chronic inflammation, aging, and genetic susceptibility; however, these factors do not fully explain the marked clinical heterogeneity of these disorders. Recent evidence suggests that the gut microbiota may influence prostatic inflammation and hyperplasia through microbial metabolites, immune regulation, and neuroendocrine pathways, giving rise to the concept of a gut-prostate axis. Animal experiments and clinical association studies have reported significant differences in gut microbial composition between patients with BPH or CP/CPPS and healthy controls, and some studies have suggested that microbiota-directed interventions, such as fecal microbiota transplantation, may have potential for alleviating pelvic pain. This narrative review selectively synthesizes evidence from published systematic reviews and original studies to discuss the relationship between the gut microbiota and BPH and CP/CPPS, evaluate the proposed mechanisms and current controversies, and outline future research directions and translational prospects.