In a recent study titled “Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis”, published in BJU International, a team of researchers from the University of Florence, Italy, has reviewed the available data on metabolic syndrome (MetS) and benign prostatic enlargement (BPE), focusing on all the components of MetS and their relationship with prostate volume, transitional zone volume, prostate-specific antigen and urinary symptoms.

MetS is an epidemic disorder that can have a high socioeconomic impact, due to its association with increased morbidity and mortality. It includes several medical conditions, including abdominal obesity, impaired glucose metabolism, hypertriglyceridaemia, low high-density lipoprotein (HDL) cholesterol and arterial hypertension.

Clinical evidence exists that supports an association between MetS and prostatic diseases, including lower urinary tract symptoms (LUTS). This prostatic condition, especially in men over 50 years of age, may compromise a man’s quality of life and is commonly attributable to BPE. Treatment options such as transurethral resection of the prostate and laser-based alternatives are associated with symptom improvement, however they can result in morbidity rates as high as 20%.

In this study, the authors preformed a detailed medical database search with the specific ‘metabolic syndrome’, ‘diabetes’, ‘hypertension’, ‘obesity’ and ‘dyslipidaemia’ keywords combined with ‘lower urinary tract symptoms’, ‘benign prostatic enlargement’, ‘benign prostatic hyperplasia’ and ‘prostate’.

This search came up with several articles, however only 8 studies were included in the author’s review. The studies analyzed a total of 5,403 patients, of which 26.4% had MetS. The authors noted that individuals with MetS had a significant increase in total prostate volume when compared with those without MetS. On the contrary, the authors observed no differences in the relation between MetS and LUTS.

Importantly, statistical analysis demonstrated that older obese men had the biggest differences in total prostatic volume.

As the authors write in their study, “The present results suggest that the MetS construct, and in particular dyslipidaemia and central obesity, is specifically associated with a greater overall (and transitional) prostate volume increment”. These results further highlight “the exacerbating role of MetS-induced metabolic derangements in the development of BPE. Obese, dyslipidaemic, and aged men have a higher risk of having MetS as a determinant of their prostate enlargement”, the authors conclude.