Clinical, Anthropometric, Metabolic and Insulin Profile of Men with Fast Annual Growth Rates of Benign Prostatic Hyperplasia

Abstract

The purpose of this study was to test the hypothesis of a causal relationship between high insulin levels and the development of benign prostatic hyperplasia (BPH) and to determine the clinical, anthropometric, metabolic and insulin profile in men with fast-growing BPH compared with men with slow-growing BPH. The present study was designed as a risk factor analysis of BPH in which the estimated annual BPH growth rate was related to components of the metabolic syndrome. Two hundred and fifty patients referred to the Urological Section, Department of Surgery, Central Hospital, Varberg, Sweden, with lower urinary tract symptoms with or without manifestations of the metabolic syndrome were consecutively included. The prevalences of atherosclerotic disease manifestations, non-insulin-dependent diabetes mellitus (NIDDM) and treated hypertension were obtained. Data on blood pressure, waist and hip measurement, body height and weight were collected and body mass index (BMI) and waist/hip ratio (WHR) were calculated. Blood samples were drawn from fasting patients to determine insulin, total cholesterol, triglycerides, HDL and LDL cholesterol, uric acid, alanine aminotransferase (ALAT) and prostate-specific antigen (PSA). The prostate gland volume was determined using ultrasound. The median annual BPH growth rate was 1.04 ml/year. Men with fast-growing BPH had a higher prevalence of NIDDM (p = 0.023) and treated hypertension (p = 0.049). These patients were also taller (p=0.004) and more obese as measured by body weight (p<0.001), BMI (p=0.026), waist measurement (p <0.001), hip measurement (p = 0.006) and WHR (p=0.029). Moreover, they had elevated fasting plasma insulin levels (p = 0.018) and lower HDL cholesterol levels (p = 0.021) than men with slow-growing BPH. The annual BPH growth rate correlated positively with diastolic blood pressure (rs = 0.14; p = 0.009), BMI (rs = 0.24; p < 0.001) and four other expressions of obesity and fasting plasma insulin level (rs = 0.18; p = 0.008), and negatively with the HDL cholesterol level (rs = -0.22; p = 0.001). In conclusion, the data suggest that NIDDM, hypertension, tallness, obesity, high insulin and low HDL cholesterol levels constitute risk factors for the development of BPH. The results also suggest that BPH is a component of the metabolic syndrome and that BPH patients may share the same metabolic abnormality of a defective insulin-mediated glucose uptake and secondary hyperinsulinaemia, as patients with the metabolic syndrome. The findings support the hypothesis of a causal relationship between high insulin levels and the development of BPH, and give rise to a hypothesis of increased sympathetic nerve activity in men with BPH.

Hyperinsulinaemia as a Risk Factor for Developing Benign Prostatic Hyperplasia

“…The total prostate gland volume, rather than the TZ volume, seems to be the most appropriate BPH expression when exploring the metabolic profile of men with fast–growing BPH compared with men with slow–growing BPH. Thus, this conclusion validates the results of the present and our previous reports [15, 16]. …”

“…In previous studies, we have hypothesized that hyperinsulinaemia is the systemic causal factor in the development of BPH [15, 16]. Hyperinsulinaemia is one of the components of the metabolic syndrome.…”

“…Of these patients, 250 had been included in our previous study [16]. One hundred and fourteen of the men, constituting a subgroup, were consecutively subjected to determination of the TZ volume in addition to the total prostate gland volume.…”

“…We have recently proposed a hypothesis that hyperinsulinaemia is causally related to the development of BPH based on a clinical observation and two clinical studies in which the prostate gland volume was related to components of the metabolic syndrome [15, 16]. The studies gave evidence that non–insulin–dependent diabetes mellitus (NIDDM), hypertension, tallness, obesity, dyslipidaemia and hyperinsulinaemia were risk factors for the development of BPH.…”

Status of men’s health in Canada

“…Obesity has been linked to lower urinary tract symptoms (LUTS). [17][18][19] Smoking is a known risk factor for bladder cancer. 20 In many cases, sexual dysfunction is a portal to the early detection of cardiovascular disease, obesity, metabolic syndrome, hypogonadism and bone problems.…”