Metabolic syndrome and benign prostatic hyperplasia: association or coincidence?

Aleksandra Rył, Iwona Rotter, Tomasz Miazgowski, Marcin Słojewski, Barbara Dołęgowska, Anna Lubkowska, Maria Laszczyńska, Aleksandra Rył, Iwona Rotter, Tomasz Miazgowski, Marcin Słojewski, Barbara Dołęgowska, Anna Lubkowska, Maria Laszczyńska

Abstract

Background: It has been suggested that individuals with metabolic syndrome (MetS) may be prone to developing benign prostatic hyperplasia (BPH), but the direction of causality remains uncertain. The objective of this cross-sectional study was to evaluate the association between BPH and MetS in men who were referred to surgery for BPH. We were interested in identifying the anthropometric, metabolic, and hormonal factors that potentially influence the risk of both conditions.

Methods: The study was conducted on 128 males with BPH and 141 without BPH (the control group). Fasting glucose, insulin, lipid profiles, total and free testosterone, estradiol, sex-hormone binding protein (SHBG), dehydroepiandrosterone sulfate (DHEA-S), homeostasis model assessment (HOMA-IR) index, and lipid accumulation product (LAP) were all evaluated.

Results: The prevalence of MetS was higher in patients with BPH than in the controls (58 vs. 41 %; P = 0.007). In comparison to the controls, patients with BPH had higher levels of cholesterol, low density lipoproteins, DHEA-S, insulin, and HOMA-IR, but lower levels of high-density lipoproteins (HDL), estradiol, and SHBG. The significant predictors of BPH were MetS (OR = 1.961), age (OR = 0.11), HDL (OR = 0.91), insulin (OR = 1.224), SHBG (OR = 0.98), and estradiol (OR = 0.978). Waist circumference and LAP inversely correlated with total and free testosterone and SHBG.

Conclusions: Our study confirmed the frequent coexistence of MetS and BPH. This association seems to be a consequence of the MetS-related metabolic derangements, changes in the sex-hormone milieu, and lowered SHBG levels.

Keywords: Benign prostatic hyperplasia; Hormones; Metabolic syndrome.

References

    1. Briganti A, Capitanio U, Suardi N, Gallina A, Salonia A, Bianchi M, et al. Benign prostatic hyperplasia and its aetiologies. Eur Urol Suppl. 2009;8:865–871. doi: 10.1016/j.eursup.2009.11.002.
    1. Rohrmann S, Nelson WG, Rifai N, Kanarek N, Basaria S, Tsilidis KK, et al. Serum sex steroid hormones and lower urinary tract symptoms in Third National Health and Nutrition Examination Survey (NHANES III) Urology. 2007;69:708–713. doi: 10.1016/j.urology.2007.01.011.
    1. De Nunzio C, Aronson W, Freedland SJ, Giovannucci E, Parsons JK. The correlation between metabolic syndrome and prostatic diseases. Eur Urol. 2012;61:560–570. doi: 10.1016/j.eururo.2011.11.013.
    1. Coffey DS. Similarities of prostate and breast cancer: evolution, diet, and estrogens. Urology. 2001;57:31–38. doi: 10.1016/S0090-4295(00)00938-9.
    1. Favilla V, Cimino S, Castelli T, Madonia M, Barbagallo I, Morgia G. Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia. BJU Int. 2010;106:1700–1703. doi: 10.1111/j.1464-410X.2010.09459.x.
    1. Litman HJ, Bhasin S, O’Leary MP, Link CL, McKinlay JB, BACH Survey Investigators An investigation of the relationship between sex-steroid levels and urological symptoms: results from the Boston Area Community Health survey. BJU Int. 2007;100:321–326. doi: 10.1111/j.1464-410X.2007.06938.x.
    1. Antunes AA, Araújo LH, Nakano E, Muracca E, Srougi M. Obesity may influence the relationship between sex hormones and lower urinary tract symptoms. Int Braz J Urol. 2014;40:240–246. doi: 10.1590/S1677-5538.IBJU.2014.02.15.
    1. Zeng QS, Xu CL, Liu ZY, Wang HQ, Yang B, Xu WD, et al. Relationship between sex hormones levels and degree of benign hyperplasia in Chinese aging men. Asian J Androl. 2012;14:773–777. doi: 10.1038/aja.2012.32.
    1. Haghsheno MA, Mellström D, Behre CJ, Damber JE, Johansson H, Karlsson M, et al. Low 25-OH vitamin D is associated with benign prostatic hyperplasia. J Urol. 2013;190:608–614. doi: 10.1016/j.juro.2013.01.104.
    1. Joseph MA, Wei JT, Harlow SD, Cooney KA, Dunn RL, Jaffe CA, et al. Relationship of serum sex-steroid hormones and prostate volume in African American men. Prostate. 2002;53:322–329. doi: 10.1002/pros.10154.
    1. Gacci M, Corona G, Vignozzi L, Salvi M, Serni S, De Nunzio C, et al. Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis. BJU Int. 2015;115:24–31. doi: 10.1111/bju.12728.
    1. De Nunzio C, Cindolo L, Gacci M, Pellegrini F, Carini M, Lombardo R, et al. Metabolic syndrome and lower urinary tract symptoms in patients with benign prostatic enlargement: a possible link to storage symptoms. Urology. 2014;8:1181–1187. doi: 10.1016/j.urology.2014.07.018.
    1. Temml C, Obermayr R, Marszalek M, Rauchenwald M, Madersbacher S, Ponholzer A. Are lower urinary tract symptoms influenced by metabolic syndrome? Urology. 2009;73:544–548. doi: 10.1016/j.urology.2008.10.027.
    1. Park HK, Lee HW, Lee KS, Byun SS, Jeong SJ, Hong SK, et al. Relationship between lower urinary tract symptoms and metabolic syndrome in a community based elderly population. Urology. 2008;72:556–560. doi: 10.1016/j.urology.2008.03.043.
    1. Gravas S, Bachmann A, Descazeaud A, Drake M, Gratzke C, Madersbacher S, et al. Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). Eur Assoc Urol 2014. Available from: .
    1. Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ. EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines) Eur Urol. 2004;2004(46):547–554. doi: 10.1016/j.eururo.2004.07.016.
    1. Summer AE, Cowie CC. Ethnic differences in the ability of triglyceride levels to identify insulin resistance. Atherosclerosis. 2008;196:696–703. doi: 10.1016/j.atherosclerosis.2006.12.018.
    1. Miccoli R, Biamchi C, Odoguardi L. Prevalence of the metabolic syndrome among Italian adults according to ATPII definition. Nutr Metab Cardiovasc Dis. 2005;15:250–254. doi: 10.1016/j.numecd.2004.09.002.
    1. Ioachimescu AG, Brennan DM, Hoar BM, Hoogwerf BJ. The lipid accumulation product and all-cause mortality in patients at high cardiovascular risk: a PreCIS database study. Obesity (Silver Spring) 2010;18:1836–1844. doi: 10.1038/oby.2009.453.
    1. Maturana MA, Moreira RM, Spritzer PM. Lipid accumulation product (LAP) is related to androgenicity and cardiovascular risk factors in postmenopausal women. Maturitas. 2011;70:395–399. doi: 10.1016/j.maturitas.2011.09.012.
    1. Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group The metabolic syndrome: a new world-wide definition. Lancet. 2005;366:1059–1062. doi: 10.1016/S0140-6736(05)67402-8.
    1. Zhang X, Zeng X, Liu Y, Dong L, Zhao X, Qu X. Impact of metabolic syndrome on benign prostatic hyperplasia in elderly Chinese men. Urol Int. 2014;93:214–219. doi: 10.1159/000357760.
    1. Pashootan P, Ploussard G, Cocaul A, De Gouvello A, Desgrandchamps F. Association between metabolic syndrome and severity of lower urinary tract symptoms: observational study in a 4666 European men cohort. BJU Int. 2015. doi:10.1111/bju.12931. Accessed 17 September 2014.
    1. Fleshner NE, Bhindi B. Metabolic syndrome and diabetes for the urologist. Can Urol Assoc J. 2014;8(7–8 Suppl 5):S 159–S 161.
    1. Ozden C, Ozdal OL, Urgancioglu G, Koyuncu H, Gokkaya S, Memis A. The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia. Eur Urol. 2007;51:199–206. doi: 10.1016/j.eururo.2006.05.040.
    1. Vignozzi L, Rastrelli G, Corona G, Gacci M, Forti G, Maggi M. Benign prostatic hyperplasia: a new metabolic disease? J Endocrinol Invest. 2014;37:313–322. doi: 10.1007/s40618-014-0051-3.
    1. Russo GI, Castelli T, Urzì D, Privitera S, Fragalà E, La Vignera S, et al. Connections between lower urinary tract symptoms related to benign prostatic enlargement and metabolic syndrome with its components: a systematic review and meta-analysis. Aging Male. 2015;14:1–10. doi: 10.3109/13685538.2015.1062980.
    1. Brand JS, van der Tweel I, Grobbee DE, Emmelot-Vonk MH, van der Schouw YT. Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and meta-analysis of observational studies. Int J Epidemiol. 2011;40:189–207. doi: 10.1093/ije/dyq158.
    1. Bhasin S, Jasjua GK, Pencina M, D’Agostino R, Sr, Coviello AD, Vasan RS, et al. Sex hormone–binding globulin, but not testosterone, is associated prospectively and independently with incident metabolic syndrome in men: the Framingham heart study. Diabetes Care. 2011;34:2464–2470. doi: 10.2337/dc11-0888.
    1. Giovannucci E, Rimm EB, Liu Y, Leitzmann M, Wu K, Stampfer MJ, et al. Body mass index and risk of prostate cancer in US health professionals. J Natl Cancer Inst. 2003;95:1240–1244. doi: 10.1093/jnci/djg009.
    1. Bozorgmanesh M, Hadaegh F, Azizi F. Predictive performances of lipid accumulation product vs. adiposity measures for cardiovascular diseases and all-cause mortality, 8.6-year follow-up: tehran lipid and glucose study. Lipids Health Dis. 2010;9:100. doi: 10.1186/1476-511X-9-100.
    1. Lotti F, Corona G, Vignozzi L, Rossi M, Maseroli E, Cipriani S, et al. Metabolic syndrome and prostate abnormalities in male subjects of infertile couples. Asian J Androl. 2014;16:295–304. doi: 10.4103/1008-682X.122341.
    1. Gacci M, Vignozzi L, Sebastianelli A, Salvi M, Giannessi C, De Nunzio C, et al. Metabolic syndrome and lower urinary tract symptoms: the role of inflammation. Prostate Cancer Prostatic Dis. 2013;16:101–106. doi: 10.1038/pcan.2012.44.
    1. Qu X, Huang Z, Meng X, Zhang X, Dong L, Zhao X. Prostate volume correlates with diabetes in elderly benign prostatic hyperplasia patients. Int Urol Nephrol. 2014;45:499–504. doi: 10.1007/s11255-013-0555-3.
    1. Hammarsten J, Damber JE, Karlsson M, Knutson T, Ljunggren O, Ohlsson C, et al. Insulin and free oestradiol are independent risk factors for benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2009;12:160–165. doi: 10.1038/pcan.2008.50.
    1. Vikram A, Jena GB, Ramarao P. Increased cell proliferation and contractility of prostate in insulin resistant rats: linking hyperinsulinemia with benign prostate hyperplasia. Prostate. 2010;70:79–89. doi: 10.1002/pros.21041.
    1. Russo GI, Cimino S, Fragalà E, Privitera S, La Vignera S, Condorelli R, et al. Relationship between non-alcoholic fatty liver disease and benign prostatic hyperplasia/lower urinary tract symptoms: new insights from an Italian cross-sectional study. World J Urol. 2015;33:743–751. doi: 10.1007/s00345-014-1392-4.
    1. Raheem OA, Parsons JK. Associations of obesity, physical activity and diet with benign prostatic hyperplasia and lower urinary tract symptoms. Curr Opin Urol. 2014;24:10–14. doi: 10.1097/MOU.0000000000000004.

Source: PubMed

3
購読する