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Urological aspects of the metabolic syndrome

Nature Reviews Urology volume 8, pages 483–494 (2011)Cite this article

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Abstract

The metabolic syndrome is common in countries with Western lifestyles. It comprises a number of disorders—including insulin resistance, hypertension and obesity—that all act as risk factors for cardiovascular diseases. Urological diseases have also been linked to the metabolic syndrome. Most established aspects of the metabolic syndrome are linked to benign prostatic hyperplasia (BPH) and prostate cancer. Fasting plasma insulin, in particular, has been linked to BPH and incident, aggressive and lethal prostate cancer. The metabolic syndrome has also been shown to be associated with nonprostatic urological conditions such as male hypogonadism, nephrolithiasis, overactive bladder and erectile dysfunction, although data on these conditions are still sparse. Overall, the results of studies on urological aspects of the metabolic syndrome seem to indicate that BPH and prostate cancer could be regarded as two new aspects of the metabolic syndrome, and that an increased insulin level is a common underlying aberration that promotes both BPH and clinical prostate cancer. Urologists need to be aware of the effect that the metabolic syndrome has on urological disorders and should transfer this knowledge to their patients.

Key Points

  • The metabolic syndrome is a cluster of disorders, including type 2 diabetes, atherosclerotic disease manifestations, hypertension, obesity and dyslipidemia, and is prevalent in countries with Western lifestyles

  • The most important common underlying endocrine aberration of these disorders is an increased insulin level, which is also linked to benign prostatic hyperplasia (BPH) and prostate cancer

  • Most aspects of the metabolic syndrome are risk factors for BPH and prostate cancer, which seems to suggest that these tumors are themselves aspects of the metabolic syndrome

  • The metabolic syndrome is also linked to other urological conditions, such as hypogonadism, nephrolithiasis, overactive bladder and erectile dysfunction, which could suggest that these conditions are also aspects of the disorder

  • Patients should be informed about these findings, while clinicians await a definitive answer of how we can reduce the incidence and control the aggressiveness of urological aspects of metabolic syndrome

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Figure 1: The hypothetical mechanism of prostate tumor promotion by the metabolic syndrome involves lifestyle factors, including an inappropriate diet and low physical activity, which generate insulin resistance and a secondary increased insulin level.
Figure 2: Fasting plasma insulin levels in prostate cancer.
Figure 3: As our knowledge improves, we are beginning to find that the known aspects of the metabolic syndrome—type 2 diabetes, obesity, hypertension, and others—are only the tip of the iceberg.

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Acknowledgements

The authors are supported by funding from the Swedish Cancer Society and the Scientific Council, County of Halland, Sweden.

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Authors and Affiliations

  1. Department of Surgery, Section of Urology, Central Hospital, Rosenborgsgatan 2, Karlstad, S-652 30, Sweden

    Jan Hammarsten

  2. Department of Urology, Institute of Surgical Science, Sahlgrenska University Hospital, Per Dubbsgatan 1, Göteborg, S-413 19, Sweden

    Ralph Peeker

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J. Hammarsten and R. Peeker researched data for the article. J. Hammarsten wrote the manuscript, and both authors reviewed and edited the article before submission.

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Hammarsten, J., Peeker, R. Urological aspects of the metabolic syndrome. Nat Rev Urol 8, 483–494 (2011). https://doi.org/10.1038/nrurol.2011.112

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