Association of metabolic syndrome and benign prostate enlargement in young korean males

Central obesity and its association with benign prostatic hyperplasia: insights from a cross-sectional study of NHANES 2001-2008

BACKGROUND

Benign prostatic hyperplasia (BPH) is a common condition that affects elderly men, but its relationship with central obesity in the American population has not been adequately elucidated.

METHODS

In this study, we included a total of 4,625 participants from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2001 to 2008. We calculated indices related to central obesity for each participant and then employed univariate logistic regression, multivariate logistic regression, restricted cubic splines (RCS), and Akaike's Information Criterion (AIC) analysis.

RESULTS

we found that the indices of Weight, Waist Circumference (WC), waist-to-Height Ratio (WHtR), and Body Roundness Index (BRI) were significantly elevated in the BPH group. In terms of dietary intake, we found that the intake of total fat, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol was significantly higher in the BPH group, with polyunsaturated fatty acids and cholesterol meeting the criteria for both univariate and multivariate regression analyses.

CONCLUSION

Weight, WC, WHtR, and BRI can effectively improve the prediction of BPH, which may be associated with the high intake of polyunsaturated fatty acids and cholesterol. Appropriately adjusting the types and total amount of fat intake may prevent the occurrence of prostatic hyperplasia.

The pathological growth of the prostate gland in atherogenic contexts

The human prostate is an androgen-dependent gland where an imbalance in cell proliferation can lead to benign prostatic hyperplasia (BPH), which results in voiding lower urinary tract symptoms in the elderly. In the last decades, novel evidence has suggested that BPH might represent an element into the wide spectrum of disorders conforming the Metabolic Syndrome (MS). The dyslipidemic state and the other atherogenic factors of the MS have been shown to induce, maintain and/or aggravate the pathological growth of different organs, with data regarding the prostate being still limited. We here review the available epidemiological and experimental studies about the association of BPH with dyslipidemias. In particular, we have focused on Oxidized Low-Density Lipoproteins (OxLDL) as a potential trigger for vascular disease and cellular proliferation in atherogenic contexts, analyzing their putative molecular mechanisms, including the induction of specific extracellular vesicles (EVs)-derived miRNAs. In addition to the epidemiological evidence, OxLDL is proposed to play a fundamental role in the upregulation of prostatic cell proliferation by activating the Rho/Akt/p27^Kip1 pathway in atherogenic contexts. miR-21, miR-141, miR-143, miR-145, miR-155, and miR-221 would be involved in the transcription of genes related to the proliferative process. Although much remains to be investigated regarding the impact of OxLDL, its receptors, and molecular mechanisms on the prostate, it is clear that EVs and miRNAs represent a promising target for proliferative pathologies of the prostate gland.

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

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.

The association between metabolic syndrome and benign prostatic hyperplasia: a systematic review and meta-analysis

OBJECTIVE

We performed this meta-analysis to assess the association between metabolic syndrome (MetS) and benign prostatic hyperplasia (BPH).

METHOD

We conducted extensive searches on the PubMed, Science and Cochrane Library to identify all articles. Outcomes including annual prostate growth rate, prostate volume (PV), International Prostate Symptom Score (IPSS), IPSS sub-scores (voiding and storage), prostate- specific antigen (PSA), maximum urine flow rate (Qmax), post-void residual urine volume (PVR) and quality of life (QoL) were assessed.

RESULTS

21 studies with 15,317 patients were included. Patients with MetS had higher annual prostate growth rate [weighted mean difference (WMD) = 0.79; p < .001], larger PV (WMD = 2.62; p < .001), lower Qmax (WMD = -0.48; p = .001) and more PVR (WMD = 8.28; p < .001). However, no significant differences were found between two groups in IPSS (WMD = 0.20; p = .37), IPSS-voiding (WMD = -0.05; p = .78), IPSS-storage (WMD = -0.22; p = .26), PSA (WMD = 0.04; p = .43), and QoL (WMD = -0.01; p = .70).

CONCLUSIONS

The study suggested that MetS may be one of the risk factors for the clinical progress of BPH. However, further study is warranted to support these results.

Comparison of prostate size and anthropometric parameters between diabetic and non-diabetic Congolese patients who underwent transurethral prostate resection in the Democratic Republic of Congo

Background

Benign prostate hyperplasia (BPH) and type 2 diabetes mellitus are prevalent in older men, and both represent a challenge to public health. Prior studies reported a correlation between BPH and (hyper)glycaemia, a component of the metabolic syndrome, which is on the increase in sub-Saharan Africa (SSA) due to rapid modernization. This study was designed to evaluate the association of prostate volume and anthropometric parameters among diabetic and non-diabetic patients who had transurethral resection of the prostate (TURP) for BPH.

Results

We analyzed data of 159 selected patients who had TURP over a three-year period (February 2014–January 2017) for histologically confirmed BPH. Mean age in the entire cohort was 68 ± 8.5 years. Out of the 159 patients, 94 (59.1%) were non-diabetics and 65 (40.9%) were diabetics. International Prostate Symptom Score (IPSS) and fasting blood glucose were significantly higher in diabetic than in non-diabetic group (28.6 ± 4.3 vs 25.6 ± 6.4, and p 0.005; 121.7 ± 45.7 vs 85.4 ± 11.7 mg/dl, and p < 0.001, respectively). BMI and waist circumference were statistically greater in non-diabetics than in diabetics (25.1 ± 3.3 kg/m2 vs 23.6 ± 3.5 kg/m2, and p 0.008; 94.6 cm ± 10.3 vs 90.6 ± 10.4 cm, and p 0.018). Diabetic patients had larger prostate volume than non-diabetic in the working age subgroup only (< 65 years of age); beyond 65 years, this difference was not consistent (62.6 ± 23.1 cc vs 50.1 ± 20.7 cc, and p 0.027; 56.2 ± 23.7 cc vs 49 ± 20.2 cc, and p 0.15, respectively). Prostate size was significantly associated with fasting blood glucose (p = 0.002) and PSA (p = 0.027). However, prostate size was not related to age, presence of diabetes, BMI, waist circumference, IPSS, quality of life score, and duration of symptoms.

Conclusion

Prostate volume is not correlated with anthropometric parameters in diabetic and non-diabetic Congolese patients who had TURP in South Kivu. Diabetics were not obese and yet had larger prostate volume than non-diabetics < 65 years of age. It is hoped that these results would form groundwork for further studies on this topic in SSA region.

Metabolic syndrome and benign prostatic hyperplasia: An update

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities related to central adiposity and insulin resistance. Its importance is increasingly recognized as it associates with increased risks of metabolic and cardiovascular diseases. These metabolic aberrations of MetS may lead to development of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in men. A 26.5%-55.6% prevalence of MetS in men with LUTS was reported in worldwide studies. Although the exact biological pathway is not clear yet, insulin resistance, increased visceral adiposity, sex hormone alterations and cellular inflammatory reactions played significant roles in the related pathophysiological processes. Clinician should recognize the cardiovascular and metabolic impacts of MetS in men with LUTS, early risk factors optimization and use of appropriate medical therapy may possibly alter or slower the progression of LUTS/BPH, and potentially avoid unnecessary morbidities and mortalities from cardiovascular and metabolic diseases for those men.

Associations between metabolic syndrome and clinical benign prostatic hyperplasia in a northern urban Han Chinese population: A prospective cohort study

Biologic rationales exist for the associations between metabolic syndrome (MetS) and benign prostatic hyperplasia (BPH). However, epidemiologic studies have yield inconsistent results. The aim of the present study was to prospectively evaluate the associations of MetS with the risk of BPH. The presence of MetS, the number of MetS components, and the individual MetS components were evaluated. After adjusting for potential confounders, MetS was associated with increased risk of BPH (HR: 1.29; 95% CI, 1.08-1.50; p < 0.001). Compared with subjects without any MetS components, the HRs were 0.88 (95% CI, 0.67-1.09; p = 0.86), 1.18 (95% CI, 0.89-1.47; p = 0.29) and 1.37 (95% CI, 1.08-1.66; p = 0.014) for subjects with 1, 2, or ≥3 MetS components, and there was a biologic gradient between the number of MetS components and the risk of BPH (p-trend < 0.001). Central obesity and low high-density lipoprotein cholesterol were the two main divers of the associations between these two conditions, with HRs of 1.93 (95% CI, 1.14-2.72; p = 0.001) for central obesity, and 1.56 (95% CI, 1.08-2.04; p = 0.012) for low HDL-C. Our findings support the notion that MetS may be an important target for BPH prevention and intervention.

Meta-analysis of metabolic syndrome and benign prostatic hyperplasia in Chinese patients

PURPOSE

To investigate the impact of metabolic syndrome (MetS) on benign prostatic hyperplasia (BPH), focusing on MetS and its relationship with prostate volume and prostate-specific antigen (PSA) in Chinese patients by performing a meta-analysis.

METHODS

We systematically searched the PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and VIP databases from inception to November 2014. All studies investigating the impact of MetS on prostate volume and PSA among BPH patients were included. Pooled mean difference (WMD) and 95% confidence interval (CI) were used to analyze the difference between patients with MetS and those without MetS.

RESULTS

Sixteen studies enrolled 1895 BPH patients, of whom 2224 had MetS. Compared with those without MetS, BHP patients with MetS had significantly higher total prostate volume (WMD 10.15 ml; 95% CI 7.37-12.93) and serum PSA level (WMD 0.53 ng/ml; 95% CI 0.17-0.88), respectively. In addition, annual prostate growth rate in patients with MetS was higher (WMD 0.49 ml/year; 95% CI 0.24-0.73) than in those without MetS.

CONCLUSIONS

This meta-analysis supports that the presence of MetS increases total prostate volume and annual prostate growth rate in Chinese BPH patients. Future studies are needed to explain the detailed underlying mechanisms.

Body mass index, waist-to-hip ratio, and metabolic syndrome as predictors of middle-aged men's health

Purpose

There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health problems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men.

Materials and Methods

A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed.

Results

By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and metabolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction.

Conclusions

Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems.

Connections between lower urinary tract symptoms related to benign prostatic enlargement and metabolic syndrome with its components: a systematic review and meta-analysis

A significant amount of epidemiological evidences have underlined an emerging link between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement a (BPE). We aimed to assess the connections between LUTS and MetS with its components. Meta-analysis were conducted to determine the mean differences (MD) and confidence intervals of IPSS total score, IPSS-voiding, IPSS-storage and prostate volume (PV) in patients with or without MetS. Ln(odds-ratio) were calculated to estimate the risk of having moderate-to-severe LUTS (IPSS ≥ 8). Nineteen studies were identified as eligible for this systematic review, with a total of 18,476 participants, including 5554 (30.06%) with and 12,922 (69.94%) without MetS. Pooled analysis did not demonstrate significant MD of IPSS, IPSS-voiding and IPSS-storage in men with or without MetS but PV was significantly different (MD = 2.18; p = 0.03). Presence of MetS was not significantly associated with moderate-to-severe LUTS (odds ratio = 1.13; p = 0.53) and only altered serum triglycerides and diabetes were associated with this risk. The association between MetS and LUTS/BPE remain unclear and further observational studies in a population with metabolic disorders should be conducted in order to address it's potential role in determining LUTS/BPE.

Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis

OBJECTIVE

To summarise and meta-analyse current literature on metabolic syndrome (MetS) and benign prostatic enlargement (BPE), focusing on all the components of MetS and their relationship with prostate volume, transitional zone volume, prostate-specific antigen and urinary symptoms, as evidence suggests an association between MetS and lower urinary tract symptoms (LUTS) due to BPE.

METHODS

An extensive PubMed and Scopus search was performed including the following keywords: 'metabolic syndrome', 'diabetes', 'hypertension', 'obesity' and 'dyslipidaemia' combined with 'lower urinary tract symptoms', 'benign prostatic enlargement', 'benign prostatic hyperplasia' and 'prostate'.

RESULTS

Of the retrieved articles, 82 were selected for detailed evaluation, and eight were included in this review. The eight studies enrolled 5403 patients, of which 1426 (26.4%) had MetS defined according to current classification. Patients with MetS had significantly higher total prostate volume when compared with those without MetS (+1.8 mL, 95% confidence interval [CI] 0.74-2.87; P < 0.001). Conversely, there were no differences between patients with or without MetS for International Prostate Symptom Score total or LUTS subdomain scores. Meta-regression analysis showed that differences in total prostate volume were significantly higher in older (adjusted r = 0.09; P = 0.02), obese patients (adjusted r = 0.26; P < 0.005) and low serum high-density lipoprotein cholesterol concentrations (adjusted r = -0.33; P < 0.001).

CONCLUSIONS

Our results underline the exacerbating role of MetS-induced metabolic derangements in the development of BPE. Obese, dyslipidaemic, and aged men have a higher risk of having MetS as a determinant of their prostate enlargement.

Impact of metabolic syndrome on benign prostatic hyperplasia in elderly Chinese men

OBJECTIVE

The aim of the present study was to evaluate the impact of metabolic syndrome (MetS) on benign prostatic hyperplasia (BPH) in elderly Chinese men.

METHODS

A total of 401 elderly BPH patients were divided into the without or with MetS group to assess the associations of MetS and components of MetS with BPH. Urologic evaluation included prostate volume, International Prostate Symptom Score, serum prostate-specific antigen, duration of concomitant lower urinary tract symptoms (LUTS) and maximum flow rate.

RESULTS

Body mass index (BMI), waist circumference, fasting glucose, glycosylated hemoglobin, triglyceride, fasting insulin (FINS), insulin resistance assessed by homeostasis model assessment (HOMA-IR) were greater and high-density lipoprotein cholesterol (HDL-C) was lower in BPH patients with MetS than in those without MetS. The patients with MetS showed a significantly larger prostate volume (p = 0.000) and longer duration of LUTS (p = 0.006) than those without MetS. Prostate volume was positively correlated with BMI (p = 0.000), FINS (p = 0.001), HOMA-IR (p = 0.003) and inversely correlated with HDL-C (p = 0.000). Multiple linear regression analysis showed that prostate volume was significantly correlated with HOMA-IR (p = 0.015).

CONCLUSIONS

Our results suggest that MetS, BMI, low HDL-C level, increased serum insulin and especially insulin resistance are considered risk factors for prostate enlargement in elderly Chinese men.

Metabolic syndrome and prostate abnormalities in male subjects of infertile couples

No previous study has evaluated systematically the relationship between metabolic syndrome (MetS) and prostate-related symptoms and signs in young infertile men. We studied 171 (36.5 ± 8.3-years-old) males of infertile couples. MetS was defined based on the National Cholesterol Education Program Third Adult Treatment Panel. All men underwent hormonal (including total testosterone (TT) and insulin), seminal (including interleukin-8 (IL-8), seminal plasma IL-8 (sIL-8)), scrotal and transrectal ultrasound evaluations. Because we have previously assessed correlations between MetS and scrotal parameters in a larger cohort of infertile men, here, we focused on transrectal features. Prostate-related symptoms were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostate Symptom Score (IPSS). Twenty-two subjects fulfilled MetS criteria. In an age-adjusted logistic ordinal model, insulin levels increased as a function of MetS components (Wald = 29.5, P < 0.0001) and showed an inverse correlation with TT (adjusted r = -0.359, P< 0.0001). No association between MetS and NIH-CPSI or IPSS scores was observed. In an age-, TT-, insulin-adjusted logistic ordinal model, an increase in number of MetS components correlated negatively with normal sperm morphology (Wald = 5.59, P< 0.02) and positively with sIL-8 levels (Wald = 4.32, P < 0.05), which is a marker of prostate inflammation, with prostate total and transitional zone volume assessed using ultrasound (Wald = 17.6 and 12.5, both P < 0.0001), with arterial peak systolic velocity (Wald = 9.57, P = 0.002), with texture nonhomogeneity (hazard ratio (HR) = 1.87 (1.05-3.33), P < 0.05), with calcification size (Wald = 3.11, P< 0.05), but not with parameters of seminal vesicle size or function. In conclusion, in males of infertile couples, MetS is positively associated with prostate enlargement, biochemical (sIL8) and ultrasound-derived signs of prostate inflammation but not with prostate-related symptoms, which suggests that MetS is a trigger for a subclinical, early-onset form of benign prostatic hyperplasia.

Benign prostatic hyperplasia: a new metabolic disease of the aging male and its correlation with sexual dysfunctions

Metabolic syndrome (MetS) is a well-recognized cluster of cardiovascular (CV) risk factors including obesity, hypertension, dyslipidemia, and hyperglycaemia, closely associated with an increased risk of forthcoming cardiovascular disease and type 2 diabetes mellitus. Emerging evidence indicates that benign prostate hyperplasia (BPH) and its related lower urinary tract symptoms (LUTS) represent other clinical conditions frequently observed in subjects with MetS. Several modifiable factors involved in MetS determinism, such as inadequate diet, lack of physical exercise, and smoking and drinking behaviours are emerging as main contributors to the development of BPH. The pathogenetic mechanisms underlying the connection between MetS and BPH have not been completely clarified. MetS and its components, hypogonadism, and prostate inflammation probably play an important role in inducing BPH/LUTS. Although historically considered as a "normal" consequence of the aging process, BPH/LUTS should now be faced proactively, as a preventable disorder of the elderly. Type of diet and level of physical activity are now considered important factors affecting prostate health in the aging male. However, whether physical exercise, weight loss, and modifications of dietary habit can really alter the natural history of BPH/LUTS remains to be determined. Further research is advisable to better clarify these points.