Components of the metabolic syndrome—risk factors for the development of benign prostatic hyperplasia

Abstract

The purpose of the present study was to perform a BPH risk factor analysis in men, relating the prostate gland volume to components of the metabolic syndrome and to identify clues to the etiology of BPH.Our material comprised a consecutive series of 158 patients with lower urinary tract symptoms with or without manifestations of the metabolic syndrome. In this group, the measured volume of the prostate was related consecutively to potential risk factors. The diagnoses atherosclerosis, non-insulin-dependent diabetes mellitus (NIDDM) and treated hypertension were obtained from the patient's medical history. Data on blood pressure, waist and hip measure, 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, cholesterol, triglycerides, HDL and LDL-cholesterol, uric acid and ALAT. The prostate gland volume was determined using ultrasound.Our results show that there was a larger prostate gland in men with NIDDM (P 0.0058), treated hypertension (P 0.0317), obesity (P`0.0001), low HDLcholesterol levels (P 0.0132) and high insulin levels (P`0.0001) than in men without these conditions. The prostate gland volume correlated positively with the systolic blood pressure (r s 0.17; P 0.03), obesity (r s 0.34; P`0.0001) and fasting insulin (r s 0.38; P`0.0001) and negatively with HDL-cholesterol (r s À0.22; P 0.009).On the basis of our ®ndings, we concluded that NIDDM, treated hypertension, obesity, low HDL-cholesterol levels and high insulin levels constitute risk factors for the development of BPH. The results suggest that BPH is a facet of the metabolic syndrome and that BPH patients may share the same metabolic abnormality of a defective insulin-mediated glucose uptake and secondary hyperinsulinemia as patients with the metabolic syndrome. The ®ndings generate a hypothesis of a causal relationship between high insulin levels and the development of BPH. In a clinical setting, the ®ndings of the present report suggest that, in any patient presenting with BPH, the possible presence of NIDDM, hypertension, obesity, high insulin and low HDL-cholesterol levels should be considered. Conversely, in patients suffering from these conditions, the possibility of a clinically important BPH should be kept in mind.

Association between prostate-specific antigen and leptin, adiponectin, HbA1c or C-peptide among African-American and Caucasian men

“…48 Several studies also have reported hyperinsulenemia or the metabolic syndrome associated with higher PSA levels, but this was believed to be mediated through the effects of obesity and insulin on increased prostate volume and benign prostatic hyperplasia. [50][51][52][53] Thus, while the mechanisms linking C-peptide or HbA1c to PSA requires further investigation, the observed inverse relationships in this study are generally consistent with the previously reported inverse relationship between testosterone and insulin.…”

The association between body size, prostate volume and prostate-specific antigen

“…Our observation for an association between obesity or height and prostate volume are consistent with several studies evaluating prostate size or clinical BPH. 4,6,9,11 For example, Freedland et al 9 reported prostate weight was about 5 g greater among prostate cancer patients (70.2%…”

“…1 The prevalence of obesity and abdominal adipose deposition also increases with age 2,3 and changes in steroid hormone metabolism, insulin regulation, or SHBG levels associated with aging and prostatic enlargement may be accelerated with obesity. 3 However, results from research investigating the association between body mass index (BMI) 4,5 or estimated visceral adiposity 4,6 and clinically diagnosed BPH are inconsistent. Investigation of prostate volume or prostate weight may avoid subjective diagnostic criteria associated with a BPH diagnosis, and several recent studies reported BMI associated with prostate volume 7,8 and prostate weight.…”

“…9 However, BMI was not associated with prostate volume in the Baltimore Longitudinal Study of Aging. 10 Although visceral adiposity 4,6 and height 11 have been associated with clinical BPH, little is known about their relationships with prostate volume.…”

PDE5 inhibitors for LUTS

“…These have also all been shown to be risk factors for the development of ED. [45][46][47][48] AH is another component of the metabolic syndrome, involving dysregulation of parasympathetic and sympathetic tone. Penile erection is impaired by increased sympathetic tone.…”