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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 1  |  Page : 43-46

Correlation between metabolic syndrome and benign prostatic hyperplasia


1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission29-Apr-2019
Date of Decision30-May-2019
Date of Acceptance01-Jun-2019
Date of Web Publication27-Mar-2021

Correspondence Address:
Haitham M AbdElaal
Quweisna, Menoufia 32631
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_166_19

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  Abstract 


Objective
To study the relation between metabolic syndrome (MetS) and benign prostatic hyperplasia (BPH).
Background
BPH is the most common urological condition among elderly males, with multiple etiopathogenesis.
Patients and methods
This prospective study was carried out on 90 male individuals aged 45–60 years classified into three groups: group 1 included 30 normal male individuals who had neither MetS nor BPH, group 2 included 30 patients with diagnosed BPH, and group 3 included 30 patients with diagnosed criteria of MetS.
Results
The study showed that compared with the control group, MetS group has significant higher manifestations of BPH with its different parameters, such as International Prostate Symptom Score (9.47 ± 5.68 vs. 2.87 ± 1.81, P > 0.001), prostate-specific antigen (3.06 ± 2.19 vs. 1.25 ± 0.82, P > 0.001), and prostatic weight (65.3 ± 30.7 vs. 28.7 ± 7.43 P > 0.001).
Conclusion
This study confirmed the frequent coexistence of MetS and BPH. This association seems to be a consequence of MetS-related changes in the sex hormone milieu and metabolic derangements.

Keywords: benign prostatic hyperplasia, insulin resistance, metabolic syndrome, prostate-specific antigen, sex hormone


How to cite this article:
Attia AA, Yasien HA, Elgharbawy MS, AbdElaal HM. Correlation between metabolic syndrome and benign prostatic hyperplasia. Menoufia Med J 2021;34:43-6

How to cite this URL:
Attia AA, Yasien HA, Elgharbawy MS, AbdElaal HM. Correlation between metabolic syndrome and benign prostatic hyperplasia. Menoufia Med J [serial online] 2021 [cited 2021 Jun 21];34:43-6. Available from: http://www.mmj.eg.net/text.asp?2021/34/1/43/312001




  Introduction Top


Benign prostatic hyperplasia (BPH) is a very common and irritating problem of males. Approximately 25% of men older than 40 years and ∼70% of men older than 70 years have BPH [1]. On a population level, there are five broad categories of risk factors for BPH. Aside from age, the other categories are genetics, sex steroid hormones, modifiable lifestyle factors, and inflammation [2]. However, a consensus has not yet been reached among these risk factors to be a definite cause for BPH incidence and progression.

Metabolic syndrome (MetS) is a clustering of factors, including abdominal obesity, hyperglycemia, high levels of blood pressure and triglycerides, and low concentration of high-density lipoproteins (HDL) [3].

The exact pathophysiology linking BPH and MetS remains unknown. Causal etiologies for BPH focused on sex steroid hormones, genetic predisposition, and changes in detrusor with ageing [4].

Insulin resistance leads to secondary hyperinsulinemia. Secondary hyperinsulinemia stimulates the liver to produce excess free biologically active Insulin growth factor IGF-1. The latter induces visceral obesity. Obesity induces increased aromatase activity, which leads to increased estradiol levels and a decreased testosterone/estradiol balance. Hyperinsulinemia, increased IGF-1, and estradiol levels favor prostate gland growth and lead to BPH [4]. Hyperglycemia may increase cytosolic-free calcium in smooth muscle cells and neural tissues, leading to sympathetic nervous system activation. This activation may contribute to the increased smooth muscle tone of the prostate and may eventually worsen lower urinary tract symptoms (LUTS) [5].

Other studies had suggested that chronic inflammation was the causative link between MetS and LUTS and BPH [6].

The aim of the work was to study the relation between MetS and BP).


  Patients and methods Top


This prospective study was carried out during the period from June 2017 to June 2018 on 90 male individuals aged 45–60 years classified into three groups: group 1 included 30 normal male individuals who have neither MetS nor BPH. These patients were examined for symptoms and signs of BPH by digital rectal examination (DRE), and the prostate was evaluated by abdominopelvic ultrasound for the size and echogenicity. Group 2 included 30 patients diagnosed as having BPH by DRE and abdominopelvic ultrasound. The normal prostate weight is 20–30 g [7]. Our cases were considered to have BPH if the prostate weight was at least 50 g. These patients were examined for the presence of criteria of MetS by estimation of body mass index, blood pressure, fasting blood sugar, triglyceride, and HDL. The exclusion criteria for group 2 were stone former, patients with manifestations of urinary tract infections, bladder tumors, and patients on pelvic radiotherapy. Group 3 included 30 patients with diagnosed criteria of MetS. The MetS diagnosis was considered if at least three of the following parameters were present [8]: increased BMI more than 30 kg/m2, triglycerides of at least 150 mg/dl or treatment for them, HDL less than 40 mg/dl in men or specific treatment, blood pressure more than or equal to 130/85 mmHg or specific treatment, hyperglycemia with fasting blood sugar more than or equal to 100 mg/dl, or known T2DM. These patients were examined for symptoms and signs of BPH by DRE, and the prostate was evaluated by abdominopelvic ultrasound for the size and echogenicity. The study was approved by the Ethical Committee of Medical Research of Faculty of Medicine, Menoufia University. Written informed consent was obtained from all participants before the study. All individuals were subjected to measurement of the serum levels of total testosterone, free testosterone, and prostate-specific antigen.


  Statistical methods Top


Data were collected, tabulated, and statistically analyzed using an IBM personal computer with statistical package of the social sciences (SPSS) version 22 (SPSS Inc., Chicago, Illinois, USA), where the following statistics were applied: descriptive statistics, in which the quantitative data were presented in the form of mean, SD, and range, and qualitative data were presented in the form numbers and percentages, and analytical statistics, which was used to find out the possible association between studied factors and the targeted disease. The used tests of significance included Mann–Whitney test (nonparametric test), which is a test of significance used for comparison between two groups not normally distributed having quantitative variables, and analysis of variance (f) test, which is a test of significance used for comparison between three or more groups having quantitative variables. P value of less than 0.05 was considered statistically significant.


  Results Top


This study included 90 male individuals divided into three groups. Group 1 (control group) included 30 male individuals, and their age ranged from 47.0 to 59.0 years, with mean ± SD age of 53.1 ± 4.13 years. Group 2 included 30 male patients, and their age ranged from 46.0 to 60.0 years, with mean ± SD age of 55.0 ± 4.37 years. Group 3 included 30 male patients and their age ranged from 46.0 to 60.0 years, with mean ± SD age of 54.5 ± 4.16 years. There was no significant difference between the studied groups regarding their age, as P value was 0.196 [Table 1]. Among group 3 (MetS), 18 individuals had BPH criteria, representing 60%, whereas 12 individuals did not have BPH criteria, representing 40%. In group 1, the International Prostate Symptom Score (IPSS) ranged from 0 to 7, with mean ± SD 2.87 ± 1.81; prostate-specific antigen ranged from 0.16 to 2.75, with mean ± SD of 1.25 ± 0.82; prostatic weight (WT) by Ultrasound (U/S) ranged from 15.0 to 40.0, with mean ± SD 28.7 ± 7.43; total testosterone ranged from 3.99 to 10.2, with mean ± SD 7.04 ± 2.05; and free testosterone level ranged from 62.0 to 244.0, with mean ± SD of 134.2 ± 62.4. However, in group 3, all these items showed range of 1.00–21.0, with mean ± SD of 9.47 ± 5.68; range of 0.30–7.00, with mean ± SD of 3.06 ± 2.19; range of 25.0–140.0, with mean ± SD of 65.3 ± 30.7; range of 1.70–9.20, with mean ± SD of 4.67 ± 2.31; and range of 7.50–38.0, with mean ± SD of 18.8 ± 9.53, respectively, with P value less than 0.001. This means that there was a highly significant difference between the control group and MetS group regarding manifestation of BPH [Table 2]. However, MetS (group 3) have the same manifestations of BPH as the BPH group (group 2) regarding IPSS and prostatic weight (P > 0.05).
Table 1: Comparison between the studied groups regarding their age (n=90)

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Table 2: Manifestations of benign prostatic hyperplasia in metabolic syndrome group compared with control group (n=60)

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  Discussion Top


BPH is the nonmalignant enlargement of the prostate gland. It refers to stromal and glandular epithelial hyperplasia that occurs in the periurethral transition zone of the prostate that surrounds the urethra [9]. Approximately 25% of men older than 40 years and ∼70% of men older than 70 years have BPH [1].

MetS is a clustering of factors including abdominal obesity, hyperglycemia, high levels of blood pressure and triglycerides, and low concentration of HDL that significantly increase the risk of having a cardiovascular event [3].

In this study, 60% of the patients in the MetS group have BPH. This figure is co-incident with that reported by Ryl et al.,[10] who found that 58% of patients with MetS had BPH. Moreover, compared with the control group, MetS group has significant higher manifestations of BPH with its different parameters such as IPSS and prostatic WT. On the contrary, MetS has the same manifestations of BPH as the BPH group regarding IPSS and prostatic WT.

These results are coincidental with that reported by some authors [10],[11],[12],[13],[14],[15],[16],[17],[18],[19] and not in agreement with that reported by others [20],[21],[22],[23],[24].

In contrary to our results and to those who are in agreement with us, Telli et al. [25] reported that MetS has a favorable effect and improves the manifestations of BPH and those who have MetS are liable to less manifestations of BPH.

The exact mechanisms through which MetS predisposes to BPH are unknown, but it is believed to be owing to genetic predisposition, hyperinsulinemia, dyslipidemia, insulin resistance, increased IGF-1, and increased plasma and tissue catecholamines [4],[26].

Other studies blamed chronic inflammation that occurs in MetS and inflammatory cells that infiltrate the adipose tissue and prostate causing tissue re-modeling and overgrowth [27].

Antunes et al.[28] proposed that hormonal imbalance to be a causative factor for development of BPH. This matches the findings of our study that showed significantly lower levels of total testosterone and free testosterone when compared with control group. However there was a non significant difference between group II (BPH without MetS) and group 3 (MetS)regarding serum level of total and free testosterone.

These results support the hypothesis that disturbed and lowered testosterone levels play a role in the etiopathogenesis of BPH that occurs in MetS.

On the contrary, other studies have shown positive relationship between testosterone level on one side and BPH and LUTS severity on the other side [29] or no relationship between circulating sex hormones and urological symptoms [30].


  Conclusion Top


This study confirmed the frequent coexistence of MetS and BPH. This association seems to be a consequence of MetS-related changes in the sex hormone milieu and metabolic derangements.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Introduction
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