Metabolic Syndrome and Benign Prostatic Hyperplasia: Evidence of a Potential Relationship, Hypothesized Etiology, and Prevention

Abstract

Benign prostatic hyperplasia (BPH) is highly prevalent in older men and causes substantial adverse effects on health. The pathogenesis of this disease is not totally clear. Recent reports have suggested a possible relationship between metabolic syndrome (MetS) and BPH. Single components of MetS (obesity, dyslipidemia, hypertension, and insulin resistance) as well as the syndrome itself may predispose patients to a higher risk of BPH and lower urinary tract symptoms (LUTS). This may stem from changes in insulin resistance, increased autonomic activity, impaired nitrergic innervation, increased Rho kinase activity, pro-inflammatory status, and changes in sex hormones that occur in association with MetS. However, the exact underlying mechanisms that regulate the potential relationship between MetS and BPH/LUTS still need to be clarified. Increased physical activity and dietary strategies may help in decreasing the incidence of MetS and its impact on BPH/LUTS. However, differences in the definitions used to address the examined predictors and endpoints preclude the possibility of arriving at definitive conclusions.

Testosterone and farnesoid X receptor agonist INT-747 counteract high fat diet-induced bladder alterations in a rabbit model of metabolic syndrome

“…The enhancement of the RhoA/ROCK contractile signaling in bladder smooth muscle is regarded as one of the main molecular mechanisms underlying bladder overactivity and storage LUTS. It has been described that RhoA/ROCK pathway is enhanced in several pathological conditions, including MetS [2,31,45,46]. In the present study we found that MetS bladder preparations show an increased RhoA membrane docking (2.5-fold) and an increased expression of RhoA-dependent genes, such as ROCK1, alpha-SMA and desmin.…”

Prevalence of metabolic syndrome and its components among men with and without clinical benign prostatic hyperplasia: a large, cross‐sectional, UK epidemiological study

“…Changes in sex hormones may also play a role in the association between BPH and metabolic syndrome. A combination of low testosterone and high oestradiol levels may increase the risk of BPH, and this combination of hormone levels is also found in men with metabolic syndrome .…”

Correlação entre idade, intensidade de sintomas prostáticos e achados ultrassonográficos

“…Embora os fatores de risco não modificáveis, como idade, genética e geografia, desempenhem papéis importantes na etiologia da HBP, dados recentes revelaram que fatores de risco modificáveis estão associados com a prevenção da doença e alívio dos sintomas, incluindo obesidade, diabetes, dieta, atividade física e inflamação (18) . Estudos publicados na Coreia do Sul sugeriram que a perda de peso e a atividade física regular poderiam ser úteis para o alívio sintomático da HPB (19,20) . A significativa diferença na expectativa de vida entre homens e mulheres sugere que os primeiros são um grupo mais vulnerável, necessitando de programas de promoção da saúde direcionados, que atuem nos fatores de risco modificáveis, a fim de envolver o homem com a sua saúde ou gestão de doença (21) .…”