Effects of TNF Blockade on Human BPH/LUTS

Eligibility Criteria

• * Male sex
• * Age 45-80 years
• * Diagnosed by physician with BPH
• * Prostate volume ≥ 60mL
• * IPSS ≥ 8
• * Able and willing to complete questionnaires
• * Able and willing to provide informed consent
• * Able to read, write, and speak in English
• * No prior treatment with TNF inhibitor (adalimumab, etanercept, infliximab, certolizumab, golimumab)
• * No plans to move from study area in the next 6 months
• * Microscopic hematuria without appropriate workup per AUA/Society of Urodynamics, Female Pelvic Medicine \& Urogenital Reconstruction (SUFU) Guidelines
• * Positive urine culture
• * Female sex or intersex
• * Age \< 45 or \> 80 years
• * Being a prisoner or detainee
• * Urinary retention with need for catheterization
• * Gross hematuria
• * Contraindication to treatment with adalimumab (e.g., presence of sepsis or active infection, active tuberculosis, Hepatitis B infection, invasive fungal infection, lymphoma, leukemia or other active malignancy, congestive heart failure, significant hematologic abnormality, allergy to adalimumab or its components, anti-drug antibodies, congestive heart failure)
• * Diagnosis of autoimmune disease (rheumatoid arthritis, plaque psoriasis, ulcerative colitis, Crohn's disease, hidradenitis suppurativa, spondyloarthritis)
• * Interstitial cystitis
• * Pelvic or endoscopic genitourinary surgery within the preceding 6 months (not including diagnostic cystoscopy)
• * History of lower urinary tract or pelvic malignancy including prostate cancer; history of pelvic radiation therapy
• * Ongoing symptomatic urethral stricture
• * Current chemotherapy or other cancer therapy
• * Severe neurological or psychiatric disorder that would prevent study participation (e.g., bipolar disorder, psychotic disorder, Alzheimer's Disease)
• * Current moderate or severe substance use disorder