Understanding Risks of Benign Prostatic Hyperplasia

Tim Grower | Nov 9, 2017

Reviewed by H. Ballentine Carter, M.D.

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Why some men develop benign prostatic hyperplasia(BPH) and others don’t remains unclear. Recently, however, one intriguing hypothesis—based on a modest, but growing body of research—has emerged. It suggests that men who have metabolic syndrome are at increased risk for developing BPH and the frustrating urinary symptoms that can accompany it, such as a frequent or urgent need to urinate or pain during urination.

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Metabolic syndrome: part 1

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While the name “metabolic syndrome” may sound exotic, this condition is made up of a cluster of familiar health problems, including obesity, high blood sugar (or glucose), elevated blood pressure, and abnormal lipid levels. Population studies indicate that people who have this group of symptoms are at increased risk for major medical conditions such as type 2 diabetes and cardiovascular disease. Now some investigators believe that metabolic syndrome may trigger urinary difficulties, too.

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Metabolic syndrome: part 2

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The health risks caused by obesity, high blood sugar, unhealthy lipid levels, and elevated blood pressure are indisputable. But doctors have long recognized that in combination, these risk factors are particularly perilous to health. In 1975, a pair of German physicians coined the name “metabolic syndrome” to describe this cluster of symptoms.

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Metabolic syndrome: part 3

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About 1 in 3 American adults has metabolic syndrome; however, the likelihood of developing it increases with age. By one recent estimate, more than half of all men over 60 have metabolic syndrome—a concerning figure, given the health dangers it can pose. For example, a man or woman who has metabolic syndrome is five times more likely to be diagnosed with type 2 diabetes and three times more likely to develop cardiovascular disease than a person who doesn’t have it.

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Metabolic syndrome: part 4

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Consequently, the concept of metabolic syndrome has now come to be widely acknowledged by physicians as a major health concern. However, there remains some disagreement among doctors over how to define it.

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Links to BPH: part 1

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Several large studies have linked metabolic syndrome to a high risk for prostate diseases, including BPH. A 2013 Journal of Urology study of 1,899 men in the Boston area found that participants who had mild-to-moderate lower urinary tract symptoms associated with BPH were 68 percent more likely to have metabolic syndrome than men without urinary tract symptoms.

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Links to BPH: part 2

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In 2014, the journal BJU International published a review of eight studies that involved 5,403 men with BPH. Of that group, 1,426 (or roughly one-quarter) had metabolic syndrome. Each of the eight studies found that men with metabolic syndrome had larger prostates than men who lacked this cluster of conditions. Notably, the presence of metabolic syndrome was closely associated with increased growth in a segment of the prostate called the transitional zone—a hallmark of BPH.

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Links to BPH: part 3

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The authors of a 2014 study in Urology also reported finding a link between metabolic syndrome and BPH. In their study, men with BPH (median age, 67) who had metabolic syndrome had about an 80 percent increased risk of experiencing “storage” symptoms, which include the frequent or urgent need to urinate (especially at night), incontinence, and pain during urination.

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Links to BPH: part 4

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It is not clear why these symptoms developed. According to the authors, one possibility is that metabolic syndrome, which is known to affect the part of the nervous system that controls the involuntary functions of the body’s internal organs (the autonomic nervous system), may be interfering with the muscle contractions needed for normal urination.

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Links to BPH: part 5

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The scientists who conducted the BJU International study offer a different hypothesis. They noticed that a common thread among men with enlarged prostates in their study was low levels of high-density lipoprotein (HDL) cholesterol, which clears unhealthy low-density lipoprotein (LDL) cholesterol from the body. Findings from a separate experiment conducted by this group showed that LDL can promote growth and inflammation of prostate cells—at least in a test tube.

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Links to BPH: part 6

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Other studies found that lab animals that were fed a high cholesterol diet developed enlarged, inflamed prostates. More support for the idea of a cholesterol connection comes from a study of 791 men with BPH. The researchers found that taking statin drugs, which lower cholesterol, reduced prostate volume.

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How to improve lifestyle: part 1

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More research is needed before doctors can say definitively whether metabolic syndrome causes or worsens BPH. Also, there is little, if any, formal research confirming that reversing metabolic syndrome will help prevent BPH or relieve its symptoms. Still, addressing three lifestyle factors that are known to increase the risk of developing metabolic syndrome—lack of physical activity, poor diet, and abdominal obesity—is likely to be good for your prostate, too.

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How to improve lifestyle: part 2

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In fact, there is solid evidence that exercising regularly can help prevent BPH. Studies suggest that even light physical activity performed on a routine basis, such as taking a walk every day, lowers the risk for developing BPH symptoms by about 30 percent. Ramping up the intensity of your workouts can lower the risk even more. It’s important, though, to get your doctor’s OK before you start an exercise program, particularly if you’ve been sedentary.

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How to improve lifestyle: part 3

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While there is no specific diet to reduce the risk of BPH, the American Heart Association recommends following a heart-healthy meal plan that includes plenty of whole grains, fruits, vegetables, and fish to lower your risk of developing metabolic syndrome. An added bonus: Increasing your physical activity and following a heart-healthy eating plan are proven ways to tackle any extra pounds you might need to lose.