OBJECTIVE: To study the association and possible relationship of prostate inflammation with benign prostatic hyperplasia (BPH), and prostate cancer. METHODS: The medical records and pathological findings of all Saudi patients who underwent transrectal ultrasound guided prostatic needle biopsies in King Abdulaziz University Medical City, Jeddah, Kingdom of Saudi Arabia from June 2003 to June 2008 were reviewed retrospectively. The indications for biopsy were elevated levels of serum prostate specific antigen, abnormal findings on digital rectal examination, or both. The specimens harboring inflammation, adenocarcinoma, BPH, or their combinations, were selected and included in the study. RESULTS: A total of 214 patients were selected with an age ranging from 37-100 years (median=68). Inflammation was histologically evident in 88 patients. Of them, only one demonstrated acute inflammation, while 87/88 demonstrated chronic inflammation with, or without acute inflammation. Histopathologic features were categorized into 3 main categories: inflammation alone (12/214, 5.6%), BPH category (126/214, 58.9%), and cancer category (76/214, 35.5%) patients. The last 2 categories also included cases associated with inflammation. In the overall analysis of 214 specimens, BPH with inflammation was more prevalent than cancer with inflammation (43/214 [20.1%] versus 33/214 [15.4%]). In a subgroup analysis within each category, inflammation was less prevalent in the BPH category compared to the cancer category (43/126 [34.1%] versus 33/76 [43.4%]). CONCLUSION: The association between chronic inflammation and both BPH and cancer is obvious in our study. Further studies are needed to substantiate this observation, and to clarify the magnitude of association of inflammation with BPH compared to cancer.