Risk Factors For Benign Prostatic Hyperplasia Research Articles

A genetic study to identify pathogenic mechanisms and drug targets for benign prostatic hyperplasia: a multi-omics Mendelian randomization study

Benign prostatic hyperplasia (BPH) as a common geriatric disease in urology, the incidence and prevalence are rapidly increasing with the aging society, prompting an urgent need for effective prevention and treatment of BPH. However, limited therapeutic efficacy and higher risk of complications result in the treatment of BPH remaining challenging. The unclear pathogenic mechanism also hampers further exploration of therapeutic approaches for BPH. In this study, we used multi-omics methods to integrate genomics, transcriptomics, immunomics, and metabolomics data and identify biomolecules associated with BPH. We performed transcriptomic imputation, summary data-based Mendelian randomization (SMR), joint/conditional analysis, colocalization analysis, and FOCUS to explore high-confidence genes associated with BPH in blood and prostate tissue. Subsequently, three-step SMR was used to identify the DNA methylation sites regulating high-confidence genes to improve the pathogenic pathways of BPH. We also used cis-instruments of druggable genes to conduct SMR analysis to find potential drug targets for BPH. Finally, we used MR analysis to explore the immune pathways and metabolomics related to BPH. Multiple analytical methods identified BTN3A2 (Blood: TWAS Z score = 5.02912, TWAS P = 4.93 × 10–7; Prostate: TWAS Z score = 4.89, TWAS P = 1.01 × 10–6) and C4A (Blood: TWAS Z score = 4.90754, TWAS P = 9.22 × 10–7; Prostate: TWAS Z score = 5.084, TWAS P = 3.70 × 10–7) as high-confidence genes for BPH and identified the cg14345882-BTN3A2-BPH pathogenic pathway. We also used druggable gene data to identify 30 promising therapeutic target genes, including BTN3A2 and C4A. For MR analysis of immune pathways, we identified immune cell surface molecules as well as the inflammatory factor IL-17 (OR = 1.25, 95% CI = 1.09–1.43, PFDR = 0.12, Maximum likelihood) as risk factors for BPH. In addition, we found that disulfide levels of cysteinylglycine (OR = 1.11, 95% CI = 1.05–1.18, P = 5.18 × 10–4, Weighted median), oxidation levels of cysteinylglycine (OR = 1.09, 95% CI = 1.04–1.14, P = 3.87 × 10–4, Weighted median), and sebacate levels (OR = 1.05, 95% CI = 1.02–1.08, P = 3.0 × 10–4, Maximum likelihood) increase the risk of BPH. This multi-omics study explored biomolecules associated with BPH, improved the pathogenic pathways of BPH, and identified promising therapeutic targets. Our results provide evidence for future studies aimed at developing appropriate therapeutic interventions.

The concentration of androgens and estrogens in benign prostatic hyperplasia

Background. The etiology of benign prostatic hyperplasia (BPH) has not been fully studied. The main role in the induction of prostate tissue proliferation is assigned to the metabolism of testosterone. Recently, it has been reported that one of the risk factors for BPH is a chronic violation of the blood supply to the prostate.The study objective is to determine the level of reproductive hormones in blood serum and prostate tissue when creating a model of chronic ischemia.Materials and methods. The model of chronic pelvic ischemia was created in 10 white non-linear mature rats by partial ligation of the inferior vena cava. The control group of the study consisted of 10 male rats of the same age. After 1.5 months, we performed a hormonal study in all rats (n = 20) determining the concentration of testosterone, dihydrotestosterone and estradiol in the blood and prostate tissue. Also, in all animals (n = 20), a morphological study of the prostate was performed.Results. We’ve found a significant increase in prostate mass in the main group of rats by 16.4 % (p <0.05). Animals with BPH and impaired blood supply to the prostate had changes in their hormonal status: increased levels of testosterone (p <0.05) and dihydrotestosterone (p >0.05) in the prostate tissue.Conclusion. Long-term ischemic disorders in the prostate may be a trigger factor for the development of BPH due to an increase in the concentration of testosterone.

Association of TERT gene polymorphisms with clinical benign prostatic hyperplasia in a Chinese Han population of the Northwest region.

BackgroundTo investigate the association between single nucleotide polymorphisms (rs10078761, rs12696304, rs2853669, rs16847897, rs2736100, rs10069690) of telomerase gene (TERT) and the risk clinical benign prostatic hyperplasia (BPH) in a Chinese Han population of the Northwest region.MethodsA total of 150 BPH patients and 150 healthy older males from the northwest Chinese Han population were included in this study. The sample size for this unmatched case-control study was estimated by the look-up table method. Meanwhile, the general information and disease data of patients were collected. Age was only collected in healthy control subjects for statistical correction. Genotypes were detected using a multiplex PCR + ligase detection reaction (LDR). Typing results and clinical data were statistically analyzed using multiple linear regression and logistic regression. Pearson correlation was used for Hardy-Weinberg equilibrium.ResultsThe included population is in Hardy-Weinberg equilibrium. There was no significant association between SNP and the risk of BPH by correlation analysis. However, 4 haplotypes (TCTGGT, TCTGTC, TGCCTC, and TGTGTC) were identified as risk factors of BPH by haplotype analysis. The SNP rs2853669 is an independent risk factor for smooth muscle type of hyperplasia. Besides, rs2736100, rs10078761, and rs10069690 which are in linkage disequilibrium are associated with the severity of BPH.ConclusionsPolymorphism of the TERT gene determines the different disease development and pathological manifestations of BPH in the Chinese Han population the Northwest region.

Prevalence and Risk Factors of Benign Prostatic Hyperplasia among Men Attending Naturopathic Health Centers in the Adenta Municipality

Background: Many epidemiological studies have demonstrated a high prevalence of benign prostatic hyperplasia (BPH) and allopathic management in different parts of the world but little is known in the area of naturopathy. The objective of the present study was to establish the prevalence and risk factors of BPH in naturopathic health centers from Adenta Municipality, Ghana. Methods: The study performed a cross-sectional study design to estimate the prevalence of benign prostatic hyperplasia in naturopathic health centers among respondents aged thirty (30) and above years old. The study also adopted convenience and purposive sampling in selecting its 30 respondents. Results: The prostatic-specific antigen (PSA) of all the respondents was high. The associated risk factors were age, financial challenges, hypertension, diabetes, hypercholesterolemia, history of prostate and hormonal disturbance, red meat consumption, smoking, alcohol abuse and stress (p-value<0.005) respectively. Majority adopted naturopathic methods of treatment and saw improvement in the symptoms. Naturopathic approaches utilized were diet and clinical nutrition, homeopathy, botanical medicine. Conclusion: The prevalence of BPH is still high among all age groups from the young to old. This is partly due to financial challenges, financial challenges and stress, family history of prostate, high arterial hypertension, diabetes, prostate disturbances, increased cholesterol, red meat consumption, smoking and alcohol abuse. Naturopathic method of treatment can be used to manage BPH.

Knowledge Of Benign Prostatic Hyperplasia And Ultrasound Screening Among Non-Academic Males Of A University Community In Enugu, South- East, Nigeria

Benign Prostatic Hyperplasia (BPH) is a worldwide disorder among men. Studies have shown that high proportion of adult males have symptoms of benign prostatic hyperplasia in Nigeria. The aim of this work is to assess the knowledge of elderly men about prostatic hyperplasia and its implication which should prompt them to go for medical advice and also their knowledge of sonographic screening among males in the community. A prospective cross sectional study was conducted among non academics males of a University community in Enugu state south-East Nigeria, using a semi structured questionnaire. Informed consent was obtained from participants in the study, acceptance to participate was considered as consent. The questionnaire had two sections, A and B. Section A assessed their demography including educational level and section B assessed the objectives of the study which included knowledge of signs and symptoms as well as the risk factors of benign prostatic hyperplasia. The respondents with higher education had better knowledge of the disorder than those with lower education. A range of 75.4% to 96.7% with a mean of 85.6% (x = 85%) did not know the signs and symptoms of benign prostatic hyperplasia. A range of 59.2% to 97.5% with a mean of 67.2% (x = 67.2%) did not know the risk factors. 52.1% did not know that simple ultrasound screening could be carried out for benign prostatic hyperplasia. The knowledge of the signs and symptoms as well as the risk factors for BPH was higher among the more educated subjects. Generally, the knowledge was also poor among the educated. Therefore, apart from formal education, other forms of education are necessary to raise the knowledge in order to prompt the elderly men to seek medical advice. General education on benign prostatic hyperplasia to the public for both educated and lesser educated will enhance time of presentation for medical advise and hence better prognosis.

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

The epidemiology of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) is continuously evolving with an increasing life span and the prevalence of metabolic diseases, including obesity, diabetes, cardiovascular disease, and hypertension. As a result, there is a substantial financial strain on health care. Recent studies and clinical trials have strengthened the relationship of known risk factors of BPH and LUTS. These include metabolic syndrome, diabetes, obesity, hypertension, and elevated serum dihydrotestosterone. Excessive consumption of red meat, saturated fat, bread, poultry, and starch was positively associated with symptomatic LUTS. Efforts to enhance treatment adherence, a healthy diet, and moderate physical exercise were noted as factors that can improve the treatment and management of BPH and LUTS. BPH is a prevalent condition among aging men. As it becomes a clinical entity through the development of LUTS, it significantly reduces the quality of life of those affected through sub-optimal bladder storage, voiding difficulties, and sexual dysfunctions. Many of the risk factors for BPH and LUTS can be reduced through moderate to intense physical exercise and consumption of dietary s-carotene, polyunsaturated fatty acids, linoleic acid, zinc, and vitamin A and C.

Prevalence of Benign Prostatic Hyperplasia (BPH) in Saudi Patients above 40 Years Old

Background: Benign prostatic hyperplasia (BPH) is a common disorder amongst older men, and is accountable for significant disability. Objective: The aim of the study is to determine the prevalence of benign prostatic hyperplasia in urology department of Prince Mutaib hospital in Sakaka, Aljouf. Methods: Via recoding, 345 patients attended the urology department. They were asked about their ages, if they are smokers and if they have chronic diseases. Results: The total number of patients diagnosed as having benign prostatic hyperplasia (BPH) was 82. This showed a prevalence rate of 23%. The age distribution of the patients was found to be above 60 years old. While regarding the symptoms: 23 (28%) of the patients showed mild BPH, 39 (48%) with moderate BPH, and 20 (24%) with severe BPH. Conclusion and recommendation: BPH seemed to be a problem of elderly patients, as within the studied patients, those with BPH were above 60 years. Chronic diseases such as diabetes mellitus, hypertension may be acting as risk factors for BPH. Further studies are recommended to study the prevalence of prostatic carcinoma in elderly patients.

Comparative analysis of resected prostate weight in diabetic and non-diabetic benign prostatic hyperplasia Patients.

Background:Benign prostatic hyperplasia (BPH) is the most common benign tumor in men. The etiology of BPH is still unresolved and multiple systems are likely to be involved. The effects of diabetes on urinary system are a risk factor for BPH. We then assessed the effects of diabetes on the parameters related to BPH, especially weight and volume.Methods:This study was conducted on patients with BPH who underwent surgery during 2010-2013. The patients’ demographic and clinical data including age, height, weight, history of diabetes, abdominal sonography, prostate-specific antigen(PSA), fasting blood sugar (FBS), triglyceride, and cholesterol, resected sample weight, and pathological diagnosis were extracted.Results:The mean age of all 225 patients (35 (15.6%) diabetic patients and 190 (84.4%) non-diabetic patients) who entered the study was 71.5±8.7 years. The patients were divided in to 3 body mass index (BMI) groups: 48 (21.3%) were normal, 151 (67.1%) were overweight and 26 (11.6%) were obese. The mean weight of resected prostate was higher in diabetic patients (22.9±6.9 vs 21.7±14.3, P=0.02). The resected prostate weight had a significant relationship with BMI (P=0.001), prostate–specific antigen (PSA) level (P=0.001), and prostate volume sonography (P=0.001). No significant relationship was detected between resected prostate weight with age, FBS and triglyceride however, it is significant with cholesterol.Conclusion:We concluded that diabetes has a role in the development and progression of BPH with effect on prostate weight and volume. As well, BMI is a risk factor in BPH progression.

Promoter polymorphisms of NDUFA4 gene were associated with prostate enlargement of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is considered the most common prostate disease in elderly men. Recent studies have suggested that specific polymorphisms might be contributed to risk factors for development of BPH. The aim of present study is to investigate whether promoter single nucleotide polymorphisms (SNPs) of the NDUFA4, mitochondrial complex associated (NDUFA4) gene are risk factors for BPH in Korean men. To evaluate the associations between promoter SNPs (rs17163801, rs17163803, rs1681288, and rs3761817) of NDUFA4 gene and clinical progress of BPH, one hundred eighty one BPH patients were recruited from Department of Urology at Kyung Hee Hospital. Prostate volume, international prostate symptom score (IPSS), and prostate specific antigen (PSA) were measured. For genetic analysis, SNPStats and SPSS 22.0 were performed. Genetic models (codominant, dominant, recessive, and log-additive models) were applied to calculate the odds ratio (OR), 95% confidence interval (CI), and P value. Among tested four SNPs, three promoter SNPs (rs17163803, rs1681288, and rs3761817) showed significant associations with prostate volume after Bonferroni’s correction (rs17163803, OR=3.00, 95% CI=1.31-6.84, Pc=0.036 in codominant 1 model; rs1681288, OR=3.53, 95% CI=1.65- 7.56, Pc=0.004 in codominant 1 model; OR=2.98, 95% CI=1.47-6.05, Pc=0.0072 in dominant model; rs3761817, OR=3.86, 95% CI=1.79-8.31, Pc=0.004 in codominant 1 model; OR=3.25, 95% CI=1.59- 6.62, Pc=0.0032 in dominant model; OR=2.19, 95% CI=1.21-3.99, Pc=0.0296). The results of present study demonstrate that specific promoter polymorphisms (rs17163803, rs1681288, and rs3761817) of the NDUFA4 gene might be associated with prostate enlargement in Korean men.

Abstract B20: The cholesterol metabolite, 27-hydroxycholesterol induces hyperplasia in an androgen receptor-dependent manner in normal prostate RWPE-1 cells

Abstract For every 6 men, 1 will be diagnosed with prostate cancer (PCa). Moreover, benign prostatic hyperplasia (BPH) also occurs in 50% of men over the age of 50. Although Androgens are known to play an important role in PCa and BPH, some evidence shows estrogens may be involved as well. Recently a cholesterol oxidized metabolite (oxysterol), 27- hydroxycholesterol (27-OHC) was found to bind to estrogen receptor(ER) and act as a selective ER modulator (SERM). 27-OHC is the most prevalent cholesterol metabolite present in the blood with levels increasing with oxidative stress and age, especially in men. The role of 27-OHC in PCa and BPH remains to be investigated. We propose that 27-OHC has deleterious effect in PCa and BPH, whereas the effect on BPH may be androgen dependent. We recently found that incubation with 27-OHC of RWPE-1 (normal epithelial) and LNCaP (cancer cells) increased cell proliferation in both cell lines. Interestingly, upon incubation of RWPE-1 and LNCaP with 27-OHC, we observed an increase in androgen receptor (AR) activity in RWPE-1, not in LNCaP. Furthermore, we found an increase in AR binding to the Androgen Response Element upon exposure of RWPE-1 to 27-OHC. We also found that upon silencing AR gene expression, 27-OHC-induced proliferation in RWPE-1 was markedly attenuated. Additionally, 27-OHC also diminished Docetaxel-mediated apoptosis in RWPE-1. Altogether, our results propose dysregulated levels of 27-OHC as a new risk factor for BPH and PCa. This indicates a novel role for 27-OHC in the etiopathogenesis of BPH and PCa. Citation Format: Shaneabbas Raza, Megan Meyer, Bin Guo, Kimberly Hammer, Othman Ghribi. The cholesterol metabolite, 27-hydroxycholesterol induces hyperplasia in an androgen receptor-dependent manner in normal prostate RWPE-1 cells. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B20.

Association between Insulin Resistance and Benign Prostatic Hyperplasia in Healthy Middle-aged Korean Men

Background: We examined the association between insulin resistance assessed by homeostatic model assessment-insulin resistance (HOMA-IR) and benign prostatic hyperplasia (BPH) in healthy middle-aged male subjects. Methods: A cross-sectional study included 1,727 male subjects, aged 40-59 year, free of medication history for BPH who received a transrectal ultrasonography and completed a structured questionnaire in 2011. Multiple logistic regression analysis was performed to evaluate the relationships of HOMA-IR with BPH across the tertile of HOMA-IR. Results: The prevalence of BPH was 24.4% (421 out of 1,727). It was increased across HOMA-IR tertiles in crude and age-adjusted models. In a multivariable-adjusted model after adjusting potential confounders such as age, body mass index (BMI), triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), alcohol consumption, smoking, exercise and meat consumption, odds ratios (95% confidence intervals, CIs) of BPH for 2nd tertile and 3rd tertile compared to 1st tertile were 1.76 (1.31-2.35), and 1.83 (1.34-2.48), respectively. Conclusions: In middle-aged, healthy men, higher HOMA-IR was significantly associated with higher prevalence of BPH, supporting insulin resistance as an independent risk factor for BPH. Korean J Health Promot 2015;15(4):202-208

Prostate volume correlates with diabetes in elderly benign prostatic hyperplasia patients

To evaluate the relationship between prostate volume (PV) and diabetes mellitus (DM) in geriatric benign prostatic hyperplasia (BPH) patients. One hundred and seventeen geriatric patients with BPH were retrospectively studied between 2008 and 2009. Patients were divided into two groups: BPH and BPH with DM group. The effects of indexes of DM, including fasting blood glucose (FBG), 2-h postprandial blood glucose, glycosylated hemoglobin (HbA1c), fasting insulin (FINS), insulin resistance (IR) index, prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), and lower urinary tract symptoms (LUTS) were evaluated. The values of PV (P = 0.005), PSA (P = 0.013), and IPSS (P = 0.01) in the BPH patients with DM group were significantly higher than in the BPH group. The values of PV (P = 0.002) and PSA (P = 0.006) in the BPH patients with elevated FBG were significantly higher than in the BPH patients with normal FBG. BPH patients with elevated HbA1c had significantly higher PV than BPH patients with normal HbA1c (P = 0.046). BPH with hyperinsulinemia group showed significantly higher PV (P = 0.017) and longer duration of LUTS (P = 0.031) than BPH patients with normal FINS. Similarly, BPH patients with IR had higher PV (P = 0.004) and longer duration of LUTS (P = 0.036) than BPH patients without IR. The logistic regression analysis showed that FBG and FINS were the risk factors for BPH. Our study demonstrates that PV is closely correlated with diabetes and diabetes has a direct effect on the occurrence and development of BPH.

1604 CONTRACTIONS OF PROSTATES FROM SPONTANEOUSLY HYPERTENSIVE RATS ARE EFFICIENTLY INHIBITED BY SILODOSIN

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research1 Apr 20131604 CONTRACTIONS OF PROSTATES FROM SPONTANEOUSLY HYPERTENSIVE RATS ARE EFFICIENTLY INHIBITED BY SILODOSIN Roberta Buono, Paolo Dell'Oglio, Giovanni La Croce, Fabio Benigni, Francesco Montorsi, and Petter Hedlund Roberta BuonoRoberta Buono MILAN, Italy More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio MILAN, Italy More articles by this author , Giovanni La CroceGiovanni La Croce MILAN, Italy More articles by this author , Fabio BenigniFabio Benigni MILAN, Italy More articles by this author , Francesco MontorsiFrancesco Montorsi MILAN, Italy More articles by this author , and Petter HedlundPetter Hedlund Linkoping, Sweden More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3154AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Silodosin, a highly selective α1A- AR antagonist improves lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). Hypertension is a risk factor for BPH and LUTS. Silodosin reduce bladder dysfunction in spontaneously hypertensive rats (SHR). It is not known if silodosin has similar effect on prostate contractility in individuals with or without hypertension. We therefore compared the effects of silodosin, tamsulosin (moderate α1A and α1D selective AR antagonist) and Y27632 (Rho-kinase inhibitor) on nerve-induced contractions of prostates from SHR and Wistar-Kyoto (WKY) controls without hypertension. METHODS After ethical approval, prostate preparations from 4 month old SHR (n=10) and WKY (n=9) rats were functionally evaluated in organbaths. A Grass Polygraph and a Biopac system recorded isometric tension. Nerves were transmurally activated by electrical field stimulation (EFS) with a Grass S48 stimulator (20Hz). Concentration-response curves (0.1-100μM) for silodosin, tamsulosin, or Y27632 were determined. The pIC50 values were determined by linear interpolation. An ANOVA was used for statistical comparisons. RESULTS Resting tensions (RT), responses to 60mM potassium (K), and contractions to EFS were similar for prostate preparations from all rats. For WKY, RT, K and EFS were 1.2±0.1, 0.21±0.03, and 0.10±0.02 mN. Corresponding values were 1.4±0.1, 0.22±0.03, and 0.12±0.02 mN for SHR. All the investigated drugs concentration-dependently inhibited EFS-induced contractions of prostate preparations from WKY and SHR with maximal inhibitory activities (Emax) at 100μM. For silodosin, Emax was 76±8% (p<0.05 vs Y27632) and 94±8% (p<0.05 vs tamsulosin) in prostate preparations from WKY and SHR, respectively. In comparison, Emax for tamsulosin was 44±8% in WKY and 42±5% in SHR (both p<0.05 vs silodosin and Y27632). Y27632 reduced EFS contractions by 90±9% (p<0.05 vs silodosin and tamsulosin) in WKY and 93±5% in SHR (p<0.05 vs WKY). The pIC50 values were similar for the three drugs in prostate preparations from WKY. In SHR prostate preparations, the pIC50 were 5.4±0.3 (silodosin), 5.3±0.2 (Y27632), and >4 (tamsulosin; p<0.05). CONCLUSIONS Silodosin and Y27632 have equal potency and efficacy to inhibit contractions of SHR prostate preparations. Tamsulosin is less active. Considering the uroselectivity of silodosin, the current data may suggest that this α1-AR antagonist could be a preferred choice in the treatment of BPH LUTS in patients with hypertension. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e659 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberta Buono MILAN, Italy More articles by this author Paolo Dell'Oglio MILAN, Italy More articles by this author Giovanni La Croce MILAN, Italy More articles by this author Fabio Benigni MILAN, Italy More articles by this author Francesco Montorsi MILAN, Italy More articles by this author Petter Hedlund Linkoping, Sweden More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Risk factors for benign prostatic hyperplasia

This review summarizes recent findings regarding risk factors for benign prostatic hyperplasia (BPH), including new data on hormonal factors, growth factors, comorbid conditions and lifestyle, diet, and exercise as they relate to BPH. In addition, it addresses the design and measurement issues that influence the inference that can be drawn from those studies. Most of the population-based studies on BPH have provided only modest insight into risk factors for BPH. The relationships with circulating levels of steroid hormones and growth factors are still unclear, whereas the association between sexual function and BPH is fairly consistent. Whether this represents a cause and effect relationship or is due to some unobserved confounding factor remains uncertain. There are few data on lifestyle factors that may be amenable to intervention. As future studies aim to address these issues, they should be carried out with rigorous methods, bypassing as many of the methodologic shortcomings of past studies as possible.

Risk factors for surgically treated benign prostatic hyperplasia in Western Australia

To determine the relationship between personal, hormonal and lifestyle risk factors and surgically treated benign prostatic hyperplasia (BPH). A population-based case-control study was conducted in Western Australia (WA) on men aged 40-75 years who were surgically treated at public and private hospitals for BPH during 2001-2002. Controls were recruited from the WA electoral roll. Cases and controls were compared with regard to demographic and lifestyle factors and proxy measures of hormonal status using logistic regression. Data were available for 398 cases and 471 controls. No associations with BPH were found for family history of prostate cancer in father or brother, serving in the military in a combat area, pattern of baldness, smoking status, obesity, alcohol intake and occupational physical activity. The only inverse relationship was observed with heavy alcohol drinking (>30g/day), however, this was not statistically significant. An increased risk of BPH, not statistically significant, was observed for British-born men compared to Australian born and for history of vasectomy. The analysis was repeated after excluding 28% of controls with moderate and severe symptoms of BPH and 7% of cases with mild symptoms prior to surgery, and our results remained essentially unchanged. The results suggest that there are few risk factors for BPH although perhaps country of birth, vasectomy and heavy alcohol consumption may be considered further.

The Relationship between the Metabolic Syndrome and the Risk of Benign Prostatic Hyperplasia: a Hospital-Based Study from a Health Screening Population

Purpose: This case-control study was designed to investigate the possible association of the metabolic syndrome (MS) with benign prostatic hyperplasia (BPH) in healthy males. Materials and Methods: We reviewed the data of 702 men who had a general health check-up without significant evidence of disease. The database for health check-ups included demographic, anthropometric, serum-related and prostate-related data. The presence of the MS was determined according to the NCEP-ATPIII criteria. We compared prostaterelated data between the MS and the non-MS group. Testing for linear trends and logistic regression were performed to determine whether the presence of the MS was associated with an increased risk for BPH. Results: The MS was identified in 166 men (23.6%). There was an increased prevalence of both the MS and BPH along with increasing age. There was a tendency for the total prostate volume and the PSA to increase along with the an increasing number of factors related to the metabolic syndrome. In a comparison between the MS and non-MS group, there were no differences in the prostate-related variables. However, subgroup analysis in men less than 50 showed significant differences in the PSA, total volume and calculated annual growth rate. In addition, only in this group was the presence of the MS a significant risk factor for BPH (odd ratio; OR=2.21, 95% confidence interval; CI 1.28-4.75). Conclusions: The results of this study showed a weak but significant relationship between the MS and BPH, especially in men less than 50. Further longitudinal studies with a larger patient population are required to confirm our findings. (Korean J Urol 2007;48:1016-1021) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

SERUM PROSTATE SPECIFIC ANTIGEN IS A STRONG PREDICTOR OF FUTURE PROSTATE GROWTH IN MEN WITH BENIGN PROSTATIC HYPERPLASIA

We analyze patterns of prostate growth in men diagnosed with benign prostatic hyperplasia (BPH) and treated with placebo during 4 years, and determine which baseline parameters were the strongest predictors of growth. A total of 3,040 men were enrolled in the 4-year randomized, placebo controlled Proscar Long-Term Efficacy and Safety study. Of these men a subgroup of 10% underwent pelvic magnetic resonance imaging prostate volume measurement at baseline and yearly thereafter. Absolute and percent volume changes during 4 years were calculated in the 164 placebo treated men in the subgroup. The ability of age, baseline prostate volume and prostate specific antigen (PSA) to predict prostate growth in placebo treated patients was assessed by multiple linear regression analyses, receiver operator characteristics curves, and evaluations of growth stratified by tertiles of baseline serum PSA and decades of life. In placebo treated patients a steady increase in mean plus or minus standard deviation prostate volume from year to year was noted (2.5+/-6.1, 4.9+/-6.8, 6.4+/-8.5 and 7.2+/-8.8 ml. at years 1, 2, 3 and 4, respectively). Mean volume changes at 4 years ranged from -9 to +30 ml. Mean percent change from baseline ranged from 12.5% to 16.6% for men 50 to 59 years old to those 70 to 79 years old. Baseline serum PSA was a strong predictor of growth with 7.4% to 22.0% change at 4 years from the lowest to highest PSA tertiles. Annualized growth rates from baseline were 0.7 ml. per year for PSA 0.2 to 1.3, 2.1 for PSA 1.4 to 3.2 and 3.3 for PSA 3.3 to 9.9 ng./ml. Multiple linear regression analysis showed that serum PSA was a stronger predictor of prostate growth than age or baseline prostate volume. All but 1 man with baseline serum PSA greater than 2.0 ng./ml. had prostate growth during 4 years, and 32.6% of men with serum PSA less than 2.0 exhibited a decrease in volume. Serum PSA is a stronger predictor of growth of the prostate in placebo treated patients than age or baseline prostate volume. Since prostate volume is a risk factor for acute urinary retention and the need for BPH related surgery, the ability of PSA to predict prostate growth may be an important factor when considering individual treatment options for BPH. Such use of PSA represents a shift in paradigm away from focusing solely on symptoms of BPH toward a more comprehensive approach with consideration of predicting and preventing risk factors of BPH related outcomes.

Epidemiology of Benign Prostatic Hyperplasia: Present Knowledge and Studies Needed

Despite being such a common condition, morphologically prevalent in 88% of autopsies of old (greater than 80 years) men, little epidemiologic research has been undertaken on benign prostatic hyperplasia (BPH). The prevalence of BPH, and probably the incidence, increases with age although the belief that BPH is a direct consequence of aging per se still awaits proof. Many observers have concluded that the age association reflects age-related hormonal changes, although this also requires proof. BPH is a very common condition in aging men: 3 in every 10 may ultimately require surgery for this condition if current estimates of prevalence are correct. Despite its common occurrence, little is known with any degree of certainty about risk factors for BPH apart from being male, being old, and having had a pair of functioning testicles since puberty. There are good reasons why the epidemiology of BPH has remained poorly understood although the application of more epidemiologic thought could pay great dividends, particularly if prostate screening programs could be exploited maximally.