Benign Prostatic Hyperplasia and Male Lower Urinary Tract Symptoms: Epidemiology and Risk Factors

J Kellogg Parsons, J Kellogg Parsons

Abstract

The epidemiology of benign prostatic hyperplasia (BPH) and male lower urinary tract symptoms (LUTS) has evolved considerably during the past several years. The term LUTS describes a distinct phenotype and allows for a broad epidemiologic description of urinary symptoms at a population level. Although it is becoming the preferred term for studying urinary symptoms in populations, LUTS remains interconnected with BPH in the literature. The incidence and prevalence of BPH and LUTS are increasing rapidly as the US population ages. BPH and LUTS are associated with serious medical morbidities, an increased risk of falls, depression, diminished health-related quality of life, and billions of dollars in annual health care costs. Although age and genetics play important roles in the etiology of BPH and LUTS, recent insights at the population level have revealed that modifiable risk factors are likely key components as well. Serum dihydrotestosterone, obesity, elevated fasting glucose, diabetes, fat and red meat intake, and inflammation increase the risk; vegetables, regular alcohol consumption, exercise, and NSAIDs decrease the risk.

Figures

Fig. 1
Fig. 1
Broad categories of epidemiologic risk factors for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS)

References

    1. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2005;173:1256–1261. doi: 10.1097/01.ju.0000155709.37840.fe.
    1. Kupelian V, Wei JT, O’Leary MP, et al. Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) survey. Arch Intern Med. 2006;166:2381–2387. doi: 10.1001/archinte.166.21.2381.
    1. Taylor BC, Wilt TJ, Fink HA, et al. Prevalence, severity, and health correlates of lower urinary tract symptoms among older men: the MrOS study. Urology. 2006;68:804–809. doi: 10.1016/j.urology.2006.04.019.
    1. Parsons JK, Bergstrom J, Silberstein J, Barrett-Connor E. Prevalence and characteristics of lower urinary tract symptoms in men aged > or = 80 years. Urology. 2008;72:318–321. doi: 10.1016/j.urology.2008.03.057.
    1. Parsons JK, Wilt TJ, Wang PY, et al. Osteoporotic Fractures in Men Research Group: Progression of lower urinary tract symptoms in older men: a community based study. J Urol. 2010;183:1915–1920. doi: 10.1016/j.juro.2010.01.026.
    1. Jacobsen SJ, Girman CJ, Guess HA, et al. Natural history of prostatism: longitudinal changes in voiding symptoms in community dwelling men. J Urol. 1996;155:595–600. doi: 10.1016/S0022-5347(01)66461-9.
    1. Masumori N, Tsukamoto T, Rhodes T, Girman CJ. Natural history of lower urinary tract symptoms in men—result of a longitudinal community-based study in Japan. Urology. 2003;61:956–960. doi: 10.1016/S0090-4295(02)02594-3.
    1. Sarma AV, McLaughlin JC, Jacobsen SJ, et al. Longitudinal changes in lower urinary tract symptoms among a cohort of black American men: the Flint Men’s Health study. Urology. 2004;64:959–965. doi: 10.1016/j.urology.2004.06.043.
    1. Temml C, Brossner C, Schatzl G, et al. The natural history of lower urinary tract symptoms over five years. Eur Urol. 2003;43:374–380. doi: 10.1016/S0302-2838(03)00084-8.
    1. Centers for Disease Control and Prevention: Trends in aging—United States and worldwide. MMWR Morb Mortal Wkly Rep 2003, 52:101–104, 106.
    1. Parsons JK, Mougey J, Lambert L, et al. Lower urinary tract symptoms increase the risk of falls in older men. BJU Int. 2009;104:63–68. doi: 10.1111/j.1464-410X.2008.08317.x.
    1. Engstrom G, Henningsohn L, Walker-Engstrom ML, Leppert J. Impact on quality of life of different lower urinary tract symptoms in men measured by means of the SF 36 questionnaire. Scand J Urol Nephrol. 2006;40:485–494. doi: 10.1080/00365590600830862.
    1. Hu TW, Wagner TH, Bentkover JD, et al. Estimated economic costs of overactive bladder in the United States. Urology. 2003;61:1123–1128. doi: 10.1016/S0090-4295(03)00009-8.
    1. Saigal CS, Joyce G. Economic costs of benign prostatic hyperplasia in the private sector. J Urol. 2005;173:1309–1313. doi: 10.1097/01.ju.0000152318.79184.6f.
    1. Sanda MG, Beaty TH, Stutzman RE, et al. Genetic susceptibility of benign prostatic hyperplasia. J Urol. 1994;152:115–119.
    1. Pearson JD, Lei HH, Beaty TH, et al. Familial aggregation of bothersome benign prostatic hyperplasia symptoms. Urology. 2003;61:781–785. doi: 10.1016/S0090-4295(02)02509-8.
    1. Sanda MG, Doehring CB, Binkowitz B, et al. Clinical and biological characteristics of familial benign prostatic hyperplasia. J Urol. 1997;157:876–879. doi: 10.1016/S0022-5347(01)65069-9.
    1. Rohrmann S, Fallin MD, Page WF, et al. Concordance rates and modifiable risk factors for lower urinary tract symptoms in twins. Epidemiology. 2006;17:419–427. doi: 10.1097/01.ede.0000219723.14476.28.
    1. Partin AW, Page WF, Lee BR, et al. Concordance rates for benign prostatic disease among twins suggest hereditary influence. Urology. 1994;44:646–650. doi: 10.1016/S0090-4295(94)80197-5.
    1. Trifiro MD, Parsons JK, Palazzi-Churas K, et al. Serum sex hormones and the 20-year risk of lower urinary tract symptoms in community-dwelling older men. BJU Int. 2010;105:1554–1559. doi: 10.1111/j.1464-410X.2009.09090.x.
    1. • Parsons JK, Palazzi-Churas K, Bergstrom J, Barrett-Connor E: A prospective study of serum dihydrotesterone and subsequent risk of benign prostatic hyperplasia in community dwelling men: the Rancho Bernardo study. J Urol 2010 Jul 17 (Epub ahead of print). This cohort study demonstrated that higher concentrations of serum DHT increase the risk of BPH. Serum total and bioavailable testosterone are not associated with BPH risk.
    1. Kristal AR, Schenk JM, Song Y, et al. Serum steroid and sex hormone-binding globulin concentrations and the risk of incident benign prostatic hyperplasia: results from the Prostate Cancer Prevention Trial. Am J Epidemiol. 2008;168:1416–1424. doi: 10.1093/aje/kwn272.
    1. Bhasin S, Singh AB, Mac RP, et al. Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl. 2003;24:299–311.
    1. Amory JK, Wang C, Swerdloff RS, et al. The effect of 5alpha-reductase inhibition with dutasteride and finasteride on semen parameters and serum hormones in healthy men. J Clin Endocrinol Metab. 2007;92:1659–1665. doi: 10.1210/jc.2006-2203.
    1. McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:2387–2398. doi: 10.1056/NEJMoa030656.
    1. Haffner S, Taegtmeyer H. Epidemic obesity and the metabolic syndrome. Circulation. 2003;108:1541–1545. doi: 10.1161/.
    1. Meigs JB, Mohr B, Barry MJ, et al. Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men. J Clin Epidemiol. 2001;54:935–944. doi: 10.1016/S0895-4356(01)00351-1.
    1. Rohrmann S, Smit E, Giovannucci E, Platz EA. Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III) Int J Obes (Lond) 2005;29:310–316. doi: 10.1038/sj.ijo.0802881.
    1. Joseph MA, Harlow SD, Wei JT, et al. Risk factors for lower urinary tract symptoms in a population-based sample of African-American men. Am J Epidemiol. 2003;157:906–914. doi: 10.1093/aje/kwg051.
    1. Parsons JK, Carter HB, Partin AW, et al. Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab. 2006;91:2562–2568. doi: 10.1210/jc.2005-2799.
    1. Parsons JK. Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems. J Urol. 2007;178:395–401. doi: 10.1016/j.juro.2007.03.103.
    1. Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2009;182(6 Suppl):S27–S31. doi: 10.1016/j.juro.2009.07.086.
    1. Kristal AR, Arnold KB, Schenk JM, et al. Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the Prostate Cancer Prevention Trial. J Urol. 2007;177:1395–1400. doi: 10.1016/j.juro.2006.11.065.
    1. Sarma AV, Parsons JK, McVary K, Wei JT. Diabetes and benign prostatic hyperplasia/lower urinary tract symptoms—what do we know? J Urol. 2009;182(6 Suppl):S32–S37. doi: 10.1016/j.juro.2009.07.088.
    1. Parsons JK, Bergstrom J, Barrett-Connor E. Lipids, lipoproteins and the risk of benign prostatic hyperplasia in community-dwelling men. BJU Int. 2008;101:313–318. doi: 10.1111/j.1464-410X.2007.07332.x.
    1. Gupta A, Gupta S, Pavuk M, Roehrborn CG. Anthropometric and metabolic factors and risk of benign prostatic hyperplasia: a prospective cohort study of Air Force veterans. Urology. 2006;68:1198–1205. doi: 10.1016/j.urology.2006.09.034.
    1. Nandeesha H, Koner BC, Dorairajan LN, Sen SK. Hyperinsulinemia and dyslipidemia in non-diabetic benign prostatic hyperplasia. Clin Chim Acta. 2006;370:89–93. doi: 10.1016/j.cca.2006.01.019.
    1. • Kristal AR, Arnold KB, Schenk JM, et al.: Dietary patterns, supplement use, and the risk of symptomatic benign prostatic hyperplasia: results from the Prostate Cancer Prevention Trial. Am J Epidemiol 2008, 167:925–934. This analysis of the placebo arm of the Prostate Cancer Prevention Trial included several important observations with respect to diet and BPH, namely higher fat and red meat intake increase, while higher vegetable intake and regular alcohol consumption decrease BPH risk.
    1. Tavani A, Longoni E, Bosetti C, et al. Intake of selected micronutrients and the risk of surgically treated benign prostatic hyperplasia: a case-control study from Italy. Eur Urol. 2006;50:549–554. doi: 10.1016/j.eururo.2005.11.027.
    1. Dal Maso L, Zucchetto A, Tavani A, et al. Lifetime occupational and recreational physical activity and risk of benign prostatic hyperplasia. Int J Cancer. 2006;118:2632–2635. doi: 10.1002/ijc.21668.
    1. Parsons JK, Kashefi C. Physical activity, benign prostatic hyperplasia, and lower urinary tract symptoms. Eur Urol. 2008;53:1228–1235. doi: 10.1016/j.eururo.2008.02.019.
    1. Parsons JK, Im R. Alcohol consumption is associated with a decreased risk of benign prostatic hyperplasia. J Urol. 2009;182:1463–1468. doi: 10.1016/j.juro.2009.06.038.
    1. Furukawa S, Fujita T, Shimabukuro M, et al. Increased oxidative stress in obesity and its impact on metabolic syndrome. J Clin Invest. 2004;114:1752–1761.
    1. Nickel JC, Downey J, Young I, Boag S. Asymptomatic inflammation and/or infection in benign prostatic hyperplasia. BJU Int. 1999;84:976–981. doi: 10.1046/j.1464-410x.1999.00352.x.
    1. Theyer G, Kramer G, Assmann I, et al. Phenotypic characterization of infiltrating leukocytes in benign prostatic hyperplasia. Lab Invest. 1992;66:96–107.
    1. Anim JT, Udo C, John B. Characterisation of inflammatory cells in benign prostatic hyperplasia. Acta Histochem. 1998;100:439–449.
    1. Di Silverio F, Gentile V, De Matteis A, et al. Distribution of inflammation, pre-malignant lesions, incidental carcinoma in histologically confirmed benign prostatic hyperplasia: a retrospective analysis. Eur Urol. 2003;43:164–175. doi: 10.1016/S0302-2838(02)00548-1.
    1. Rohrmann S, De Marzo AM, Smit E, et al. Serum C-reactive protein concentration and lower urinary tract symptoms in older men in the Third National Health and Nutrition Examination Survey (NHANES III) Prostate. 2005;62:27–33. doi: 10.1002/pros.20110.
    1. Sutcliffe S, Giovannucci E, De Marzo AM, et al. Sexually transmitted infections, prostatitis, ejaculation frequency, and the odds of lower urinary tract symptoms. Am J Epidemiol. 2005;162:898–906. doi: 10.1093/aje/kwi299.
    1. Sutcliffe S, Zenilman JM, Ghanem KG, et al. Sexually transmitted infections and prostatic inflammation/cell damage as measured by serum prostate specific antigen concentration. J Urol. 2006;175:1937–1942. doi: 10.1016/S0022-5347(05)00892-X.
    1. Sutcliffe S, Rohrmann S, Giovannucci E, et al. Viral infections and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey. J Urol. 2007;178:2181–2185. doi: 10.1016/j.juro.2007.06.041.
    1. St Sauver JL, Jacobson DJ, McGree ME, et al. Protective association between nonsteroidal antiinflammatory drug use and measures of benign prostatic hyperplasia. Am J Epidemiol. 2006;164:760–768. doi: 10.1093/aje/kwj258.

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