Introduction
The prevalence of all cancer types, including prostate cancer (PCa), have increased with the more extensive usage of the cancer screening program. PCa has been the second most observed cancer type, while it is the fifth most common cause of death in men. 1.3 million new cases were diagnosed in the world in 2018.1 After the discovery of the prostate-specific antigen (PSA), most of the patients with PCa have been detected at an early stage. However, a digital rectal examination (DRE) or high level of PSA may be insufficient in finding the index patient. A false positive PSA level in patients with benign prostatic hyperplasia (BPH), and/or prostatitis, result in an unnecessary biopsy. The multiparametric magnetic resonance imaging (mpMRI) with a standardized reporting system (Prostate Imaging Reporting and Data System [PI-RADS] has begun being used as a clinical parameter for PCa diagnosis.2,3 Despite these improvements on the technology, the results are still controversial, and the total cost of these tests could still be a large burden on the economy of the health system. Therefore, a new diagnostic method or scoring system, which is readily available in clinical practice, is still needed for the correct decision of prostate biopsy.
The initiation, progression, and metastasis of cancer does not only depend on the type of tumor cells, but systemic inflammation and nutritional status play important roles in the development of the cancer.4-6 Recent studies have identified a new inflammation index called HALP, a combination of hemoglobin, albumin, lymphocytes, and platelets, which could show the status of both the immune system and the nutrition status of the patient. This novel score system has proven to be a good prognostic indicator in gastric, colorectal, renal, bladder, and prostate cancers.7-11However, there have been no studies which have been performed an assessment on the HALP score as a diagnostic marker of PCa. In this study we aimed to investigate if there was any statistically significant difference of the HALP score between patients with PCa or BPH.