Metabolic Syndrome and Benign Prostatic Enlargement: A Systematic Review and Meta-Analysis
Gacci M1, Corona G, Vignozzi L, Salvi M, Serni S, De Nunzio C, Tubaro A, Oelke M, Carini M, Maggi M. BJU Int. 2014 Mar 6. doi: 10.1111/bju.12728. [Epub ahead of print]

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1Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.


OBJECTIVE: Evidence suggests an association between MetS and lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). We summarized and meta-analyzed the current literature concerning MetS and BPE, focusing on all the components of MetS and their relationship with prostate volume, transitional zone volume, PSA and urinary symptoms.

METHODS: An extensive PubMed and Scopus search was performed including the following keywords: "metabolic syndrome" (MetS), "diabetes", "hypertension", "obesity" and "dyslipidaemia" combined with "lower urinary tract symptoms" (LUTS), "benign prostatic enlargement" (BPE), "benign prostatic hyperplasia" (BPH) and "prostate".

RESULTS: Out of the retrieved articles, 82 were selected for detailed evaluation, and 8 were included in this review. The eight studies enrolled a total of 5403 patients, of which 1426 (26.4%) had MetS defined according to current classification. Subjects with MetS had significantly higher total prostate volume when compared to those without MetS (+1.8 [95% CI: 0.74;2.87] ml; p<0.001). Conversely, no differences were observed between subjects with or without MetS for IPSS total or LUTS subdomain scores. Meta-regression analysis showed that differences in total prostate volume were significantly higher in older (adj r=0.09; p=0.02), obese patients (adj r=0.26; p<0.005) and low serum HDL cholesterol concentrations (adj r=-0.33; p<0.0001).

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