Advanced Prostate Cancer

Inflammation. [1] Neutrophil-to-Lymphocyte Ratio [NLR]

I have written perhaps too many posts on inflammation & prognosis. Inflammation is a treatable condition, in my view, which means that the patient can improve on his prognosis.

There are a number of markers of subclinical inflammation & the NLR is just one of them. It is often included in a basic blood test panel used at an annual medical. If not, one can calculate it from the Neutrophil & Lymphocyte numbers, which are usually reported.

This post is prompted by a new Italian study [1], but is a review of the PCa-NLR literature.

As with other inflammation studies, the emphasis continues to be on the prognostic value of the test. With a low pretreatment NLR one might do well, have lesser disease, respond to treatment, live longer, etc. With a high NLR - doom & gloom.

Serious disease results in inflammation, but we know how to counter inflammation. There is a study of healthy people (no suspicion of disease) where 5-year survival was affected by low level inflammation markers. Inflammation is not just indicative of disease, it is a major player in the outcome. A pernicious influence. Something to be avoided.

[2] Wikipedia: "In medicine neutrophil to lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. It is calculated by dividing the number of neutrophils by number of lymphocytes."

The studies began in 2012: (skip to "Conclusion" at any time)

[3] "patients treated with ketoconazole"

"Risk factors associated with the {progression-free survival} outcome were a pretreatment NLR >3 and PSA doubling time (PSADT) <3 months and a prior response to a gonadotropin-releasing hormone agonist of <24 months or to an antiandrogen of <6 months."

[4] NLR prior to Docetaxel treatment.

[4a] "patients with castration-resistant prostate cancer treated with docetaxel"

"NLR was found to be correlated with only posttreatment psa levels. In the NLR ≤3 group, the PSA levels were statistically significantly lower than the other group"

[4b] "patients with metastatic castration-resistant prostate cancer (mCRPC) treated with first-line docetaxel"

"Men who were treated with first-line docetaxel for mCRPC who had a low pretreatment NLR (≤3.0) had significantly longer {overall survival}."

[4c] "High NLR may be associated with an independent poor prognostic impact in post-docetaxel patients with mCRPC."

[4d] "Liver metastases, hemoglobin <12 g/dL, alkaline phosphatase >2.0× upper limit of normal (ULN), lactate dehydrogenase >1.2× ULN, and NLR >3 were associated with significantly worse {overall survival} in multivariable analysis."

[4e] "In the training set, both {derived} NLR ≥median (2) and duration of initial ADT <median (15 months) were associated with increased risk of death [hazard ratio (HR) 1.29 ... and HR 1.41 .., respectively] after adjustment for age, alkaline phosphatase, hemoglobin, and pain at baseline."

[4f] "The cut-off level of the neutrophil-to-lymphocyte ratio was set as the median value of 3.5 among all patients in this study."

" ... the median overall survival and progression-free survival were shorter in patients with a high neutrophil-to-lymphocyte ratio compared with those with a low neutrophil-to-lymphocyte ratio (15 vs 20 months ... and 9.5 vs 15 months ... respectively)."

[4g] "In this retrospective series, metastatic CRPC patients who started first-line docetaxel with a low pretreatment NLR had a significantly better survival."

[5] Radiation.

[5a] "an NLR ≥ 5 was selected as cutoff value for external validation. Multivariate analysis identified an increased NLR as an independent prognostic factor for clinical {progression-free survival} [hazard ratio (HR) 3.09 ...], {distant metastases-free survival} (HR 3.51 ...), and {overall survival} (HR 2.16 ...)"

[6] Radical Prostatectomy

[6a] "The value of 2.494 for NLR was found to be a cut-off value which can be used in order to distinguish recurrence according to Youden index. According to this, patients with a higher NLR value than 2.494 had higher rates of PSA recurrence with 89.7% sensitivity and 92.6% specificity."

[6b] "patients with a NLR >3 have a higher incidence of recurrence. In multivariate analysis including age, total PSA and NLR, NLR is the most important factor able to predict recurrence."

[6c] "High NLR was significantly related to unfavorable clinicopathological outcomes and worse BCR-free survival."

[6d] "Our findings suggest that the pretreatment NLR may be associated with pathological stage and lymph node involvement in PCa patients receiving RP, and that PCa patients with a high NLR may have a higher rate of biochemical recurrence following RP than those with a low NLR."

[6e] "Our results demonstrate that postoperative neutrophil-to-lymphocyte ratio is an independent factor for biochemical recurrence and overall survival in patients who underwent radical prostatectomy for prostate cancer."

[7] NLR prior to Biopsy.

[7a] "NLR, with or without combination with F/T PSA ratio, may function as a new biomarker to predict prostate cancer in men undergoing prostate needle biopsy."

[7b] "In univariate analyses, NLR was a significant predictor of prostate cancer detection"

[7c] "The GS 8-10 group had a significantly higher mean NLR compared to GS 5-6 (3.64 vs. 2.54 ...) and GS 7 (3.64 vs. 2.58 ...) patients."

[8] Xtandi (Enzalutamide)

[8a] "The median {Progression-free survival} was 3.2 months ... in patients with baseline NLR >3 and 7.4 months ... in those with NLR ≤3 .... The median {overall survival} was 10.4 months ... in patients with baseline NLR >3 and 16.9 months ... in those with baseline NLR ≤3 ..."

[9] Zytiga (Abiraterone acetate)

[9a] "SII and NLR might represent an early and easy prognostic marker in mCRPC patients treated with abiraterone."

SII = A systemic immune-inflammation index based on neutrophil, lymphocyte, and platelet counts.



Change the numbers!

To follow: "Inflammation. How to Change the Numbers"























4 Replies

Ty Patrick I'm going to read up. I'm just confused because I myself have different inflammatory diseases,,all for which there is no cure and the treatment doesn't work so tumeric, certain diet, etc help but I have looked for a way for 20 years to reduce all inflammation. I'm also aware it's a matter in any disease and it's what worries me about my dad and his pain or possible future pain. If you have discovered there's a cure all for inflammation, wouldn't there be a cure for arthritis and associated diseases? No disrespect, I truly appreciate the research and will read all. Thank you so much.


Ty I have read all and I'm thoroughly impressed and hopeful. I misread and thought that there was a basis of saying cure inflammation..cure cancer. I stand corrected, and interested in any research and so appreciative of your work.


How does one compute the NLR if the blood test provides Neutrophils Absolute value and the Lymphocytes are provided as a % value under Differential Automated. Sorry, my background is electrical engineering, not biology. Thanks for any guidance.


That's odd.

My last Life Entension (LabCorp] report shows:

"Neutrophils" %

"Lymphs" %

"Neutrophils (Absolute)"

"Lymphs (Absolute)"

But anyway, the percentage relates to the total white blood cell count.

So, unless I have messed this up:

NLR = [100 * N(abs)] / [WBC * L(%)]



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