Metabolic syndrome is associated with prostate enlargement: a systematic review, meta-analysis, and meta-regression on patients with lower urinary tract symptom factors

Abstract

Background: Metabolic syndrome (MetS) is defined by at least three of the following five criteria: blood pressure ⩾130/85 mmHg, fasting blood glucose ⩾5.6 mmol/l, triglycerides concentration ⩾1.7 mmol/l, waist circumference ⩾102 cm (for men), and high-density lipoprotein cholesterol concentration <1.03 mmol/l (for men). MetS has been associated with worse lower urinary tract symptoms (LUTS) and higher International Prostate Symptom questionnaire scores. Materials and Methods: MEDLINE, Cochrane, ClinicalTrials.gov, and SCOPUS were critically appraised for all peer-reviewed manuscripts that suitably fulfilled our protocol’s inclusion criteria established a priori. Meta-analytical and meta-regression calculations were performed in R using the Sidik–Jonkman and Hartung–Knapp random effects model and predefined covariates. Results: A total of 70 studies ( n = 90,206) were included in qualitative synthesis. From these, 60 studies focused on MetS and LUTS: 44 reported positive correlations, 5 reported negative correlations, 11 reported no association, and 10 studies focused on MetS and total prostate volume (TPV). MetS positively correlated with moderate LUTS [odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.35–1.80], severe LUTS (OR = 2.35, 95% CI = 1.82–3.03), overactive bladder (OAB; OR = 3.2, 95% CI = 1.6–5.8), and nocturia severity (OR = 2.509, 95% CI = 1.571–4.007) at multivariate analysis. A total of 30 studies ( n = 22,206) were included in meta-analysis; MetS was significantly associated with higher TPV (mean differences = 4.4450 ml, 95% CI = 2.0177–6.8723), but no significant predictive factors for effect sizes were discovered. Conclusion: Our meta-analysis demonstrates a significant association between the aggravating effects of MetS, which commonly coexists with obesity and benign prostate enlargement.

Characterizing the spectrum of bladder health and lower urinary tract symptoms among men: Results from the CARDIA study

“…In contrast to women from the CARDIA cohort study, we did not find associations of cardiovascular risk factors with LUTS/impact clusters in men 9 . Cardiovascular risk factors are associated with LUTS in men in other cohort studies 13,14,23–26 . The present study combined self‐reported symptoms and impact on QoL to create an index of bladder health.…”

“…The newer definition of cardiovascular health includes the presence of both ideal health behaviors (nonsmoking, body mass index < 25 kg/m 2 , physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol < 200 mg/dL, untreated blood pressure <120/<80 mmHg, and fasting blood glucose < 100 mg/dL), as well as getting adequate sleep 12,27 . In a recent systematic review of metabolic syndrome and LUTS in men, the authors concluded that good evidence existed to support a relationship between metabolic syndrome and prostatic enlargement, but not for LUTS 26 . Only 7% of the men in CARDIA (average age 50 ± 3.6 years) reported having a diagnosis of prostate enlargement.…”

“…9 Cardiovascular risk factors are associated with LUTS in men in other cohort studies. 13,14,[23][24][25][26] The present study combined self-reported symptoms and impact on QoL to create an index of bladder health. This, in addition to the narrow age range of men from this cross-sectional analysis of Year 25 CARDIA data, could explain discrepancies in findings from the present study of men and the broader literature.…”

“…12,27 In a recent systematic review of metabolic syndrome and LUTS in men, the authors concluded that good evidence existed to support a relationship between metabolic syndrome and prostatic enlargement, but not for LUTS. 26 Only 7% of the men in CARDIA (average age 50 ± 3.6 years) reported having a diagnosis of prostate enlargement. The low numbers of men who reported having prostate enlargement may be one reason that an association between metabolic syndrome and bladder health and symptom clusters was not observed in the present study.…”

Excess weight, weight gain, and prostate cancer risk and prognosis: the PROCA-life study

“…The lower levels of observed PSA in overweight men compared with normal-weight men may also account for some of the observed inverse association between overweight and metastatic PCa. On the other hand, obesity and metabolic syndrome have been associated with lower urinary tract symptoms (LUTS) [46,47], which may entail a more widespread use of PSA-testing, thus increasing the probability of being diagnosed with PCa at an earlier stage. Even so, the degree of LUTS have not been found to correlate with PCa [48,49].…”