Metabolic syndrome: its influence on benign prostate hyperplasia progression, lower urinary tract symptoms and the effectiveness of BPH treatment. Literature review

This review is dedicated to the analysis of recently published data related to the influence of metabolic syndrome (MS) on the development and progression of benign prostate hyperplasia (BPH) and urination disorders, which are denoted as lower urinary tract symptoms (LUTS). It has been shown that patients with MS are diagnosed with BPH significantly more often than men of the same age, who do not suffer from metabolic disorders. At the same time, the volume of the prostate was larger in patients with MS, who have recently been diagnosed with BPH, in comparison with patients without MS. Dynamic monitoring of patients with MS has demonstrated more rapid growth of prostate mass; several papers report on the rapid increase in the level of prostate specific antigen (PSA). The data related to the influence of MS on LUTS is controversive: some authors indicate the negative impact of MS on urination in patients with BPH, whereas the others do not. Several papers even describe the improvement of urination in patients with MS. These differences are claimed to be linked to ethnic factors: negative impact of MS is less significant in Asian men, in comparison with European population, as well as lifestyle and nutritional patterns. The increase in the negative impact of MS on the progression of BPH and LUTS correlates with MS factors, which are also present in patients. In this case, the main role is attributed to the disorders of lipid and carbohydrate metabolism, which is accompanied by abdominal obesity, hyperglycemia and insulin resistance, which includes diabetes mellitus type 2. The mechanisms which describe the interconnection of metabolic disorders, stimulation of prostate cells proliferation and LUTS progression are under discussion. Most publications point to the decrease in the effectiveness of medication-assisted treatment of patients with MS and BPH, in comparison with men with BPH, who do not suffer from MS. This way of treatment leads to the more often development of urinary retention and also to the necessity of surgical intervention, which leads to the normalization of urination less often, according to a number of authors. This data indicates the necessity of further research aimed at unraveling the peculiarities of BPH pathogenesis, associated with MS and also the need to improve the methods of treatment of these patients.