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  • Original Article
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Clinical Research

Metabolic syndrome and lower urinary tract symptoms: the role of inflammation

Prostate Cancer and Prostatic Diseases volume 16, pages 101–106 (2013)Cite this article

Subjects

Abstract

Background:

Epidemiological data indicate that lower urinary tract symptoms (LUTS)/BPH can be associated with metabolic syndrome (MetS). Chronic inflammation has been proposed as a candidate mechanism at the crossroad between these two clinical entities.

Aim of study is to examine the correlation among pre-operatory LUTS/BPH severity, MetS features and inflammatory infiltrates in prostatectomy specimens.

Methods:

A total of 271 consecutive men treated with simple prostatectomy were retrospectively selected for this study in two tertiary referral centers for LUTS/BPH. Prostate diameters and volume were measured by transrectal ultrasound, LUTS scored by International Prostate Symptom Score (IPSS) and obstruction by uroflowmetry. The International Diabetes Federation and American Heart Association and the National Heart, Lung and Blood Institute was used to define MetS. The inflammatory infiltrate was investigated combining anatomic location, grade and extent of flogosis into the overall inflammatory score (IS); the glandular disruption (GD) was used as a further marker.

Results:

Eighty-six (31.7%) men were affected by MetS. Prostatic volume and anterior-posterior (AP) diameter were positively associated to the number of MetS components. Among MetS determinants, only dyslipidaemia (increased serum triglycerides and reduced serum high-density lipoprotein) was associated with an increased risk of having a prostatic volume >60 cm3 (hazard ratio (HR)=3.268, P<0.001). A significant positive correlation between the presence of MetS and the IS was observed. MetS patients presented lower uroflowmetric parameters as compared with those without MetS (Maximum flow rate (Qmax): 8.6 vs 10.1, P=0.008 and average flow rate (Qave): 4.6 vs 5.3, P=0.033, respectively), and higher obstructive urinary symptoms score (P=0.064). A positive correlation among both IS–GD and IPSS Score was also observed (adjusted r=0.172, P=0.008 and adjusted r=0.128, P=0.050).

Conclusions:

MetS is associated with prostate volume, prostatic AP diameter and intraprostatic IS. The significantly positive association between MetS and prostatic AP diameter could support the observation that MetS patients presented lower uroflowmetric parameters. In conclusion, MetS can be regarded as a new determinant of prostate inflammation and BPH progression.

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References

  1. Gacci M, Eardley I, Giuliano F, Hatzichristou D, Kaplan SA, Maggi M et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2011; 60: 809–825.

    Article  Google Scholar 

  2. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al. Standardisation sub-committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61: 37–49.

    Article  Google Scholar 

  3. Samdeep M, Kevin T . McVary Lower urinary tract symptoms, obesity and the metabolic syndrome. Curr Opin Urol 2010; 20: 7–12.

    Article  Google Scholar 

  4. Roherborn CG . Pathology of benign prostatic hyperplasia. Int J Impot Res 2008; 20 (Suppl 3): S11–S18.

    Article  Google Scholar 

  5. Hammarsten J, Högstedt B, Holthuis N, Mellström D . Components of the metabolic syndrome-risk factors for the development of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 1998; 1: 157–162.

    Article  CAS  Google Scholar 

  6. Hammarsten J, Högstedt B . Calculated fast-growing benign prostatic hyperplasia—a risk factor for developing clinical prostate cancer. Scand J Urol Nephrol 2002; 36: 330–338.

    Article  Google Scholar 

  7. Nandeesha H, Koner BC, Dorairajan LN, Sen SK . Hyperinsulinemia and dyslipidaemia in non-diabetic benign prostatic hyperplasia. Clin Chim Acta 2006; 370: 89–93.

    Article  CAS  Google Scholar 

  8. Dahle SE, Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Hsing AW . Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol 2002; 168: 599–604.

    Article  CAS  Google Scholar 

  9. Ozden C, Ozdal OL, Urgancioglu G, Koyuncu H, Gokkaya S, Memis A . The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia. Eur Urol 2007; 51: 199–203.

    Article  Google Scholar 

  10. De Nunzio C, Aronson W, Freedland SJ, Giovannucci E, Parsons JK . The correlation between metabolic syndrome and prostatic diseases. Eur Urol 2012; 61: 560–570.

    Article  CAS  Google Scholar 

  11. De Nunzio C, Kramer G, Marberger M, Montironi R, Nelson W, Schröder F et al. The controversial relationship between benign prostatic hyperplasia and prostate cancer: the role of inflammation. Eur Urol 2011; 60: 106–117.

    Article  CAS  Google Scholar 

  12. Gacci M, Bartoletti R, Figlioli S, Sarti E, Eisner B, Boddi V et al. Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study. BJU Int 2003; 91: 196–200.

    Article  CAS  Google Scholar 

  13. Tubaro A, Carter S, Hind A, Vicentini C, Miano L . A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol 2001; 166: 172–176.

    Article  CAS  Google Scholar 

  14. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA et alInternational Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640–1645.

    Article  CAS  Google Scholar 

  15. Corona G, Mannucci E, Petrone L, Schulman C, Balercia G, Fisher AD et al. A comparison of NCEP-ATPIII and IDF metabolic syndrome definitions with relation to metabolic syndrome-associated sexual dysfunction. J Sex Med 2007; 4: 789–796.

    Article  Google Scholar 

  16. Curtis Nickel J . Inflammation and benign prostatic hyperplasia. Urol Clin North Am 2008; 35: 109–115.

    Article  Google Scholar 

  17. Smith AD, Badlani G, Preminger GM, Kavoussi LR . Smith’s Textbook of Endourology 3rd edn 2011.

  18. Aarnink RG, de la Rosette JJ, Huynen AL, Giesen RJ, Debruyne FM, Wijkstra H . Standardized assessmet to enhance the diagnostic value of prostate volume; part i: morphometry in patients with lower urinary tract symptoms. Prostate 29: 317–326 1996.

    Article  CAS  Google Scholar 

  19. Boyle P, Gould AL, Roehrborn CG . Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical trials. Urology 1996; 48: 398–405.

    Article  CAS  Google Scholar 

  20. Rove KO, Sullivan KF, Crawford ED . High-intensity focused ultrasound: ready for primetime. Urol Clin North Am 2010; 37: 27–35.

    Article  Google Scholar 

  21. Hammarsten J, Hogstedt B . Hyperinsulinemia as a risk factor for developing benign prostatic hyperplasia. Eur Urol 2001; 39: 151–158.

    Article  CAS  Google Scholar 

  22. Parsons JK, Carter HB, Partin AW, Windham BG, Metter EJ, Ferrucci L et al. Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab 2006; 91: 2562–2568.

    Article  CAS  Google Scholar 

  23. Lee RK, Chung D, Chughtai B, Te AE, Kaplan SA . Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms. BJU Int 2012; 110: 540–545.

    Article  Google Scholar 

  24. Fibbi B, Penna G, Morelli A, Adorini L, Maggi M . Chronic inflammation in the pathogenesis of benign prostatic hyperplasia. Int J Androl 2010; 33: 475–488.

    Article  CAS  Google Scholar 

  25. Schauer IG, Rowley DR . The functional role of reactive stroma in benign prostatic hyperplasia. Differentiation 2011; 82: 200–210.

    Article  CAS  Google Scholar 

  26. Nickel JC, Roehrborn CG, O'Leary MP, Bostwick DG, Somerville MC, Rittmaster RS . The relationship between prostate inflammation and lower urinary tract symptoms: examination of baseline data from the REDUCE trial. Eur Urol 2008; 54: 1379–1384.

    Article  Google Scholar 

  27. Roehrborn CG . Benign prostatic hyperplasia: an overview. Rev Urol 2005; 7 (Suppl 9): S3–S14.

    PubMed  PubMed Central  Google Scholar 

  28. Vignozzi L, Morelli A, Sarchielli E, Comeglio P, Filippi S, Cellai I et al. Testosterone protects from metabolic syndrome-associated prostate inflammation: an experimental study in rabbit. J Endocrinol 2012; 212: 71–84.

    Article  CAS  Google Scholar 

  29. Morelli A, Comeglio P, Filippi S, Sarchielli E, Cellai I, Vignozzi L et al. Testosterone and farnesoid X receptor agonist INT-747 counteract high fat diet-induced bladder alterations in a rabbit model of metabolic syndrome. J Steroid Biochem Mol Biol 2012; 132: 80–92.

    Article  CAS  Google Scholar 

  30. Filippi S, Vignozzi L, Morelli A, Chavalmane AK, Sarchielli E, Fibbi B et al. Testosterone partially ameliorates metabolic profile and erectile responsiveness to PDE5 inhibitors in an animal model of male metabolic syndrome. J Sex Med 2009; 6: 3274–3288.

    Article  CAS  Google Scholar 

  31. Vignozzi L, Morelli A, Filippi S, Comeglio P, Chavalmane AK, Marchetta M et al. Farnesoid X receptor activation improves erectile function in animal models of metabolic syndrome and diabetes. J Sex Med 2011; 8: 57–77.

    Article  CAS  Google Scholar 

  32. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185: 1793–1803.

    Article  Google Scholar 

  33. Crawford ED, Wilsson SS, Roehroborn CG . MTOPS study group, Baseline factors as predictors of clinical progression of benign prostatic hyperplasia in men treated with placebo. J Urol 2006; 175: 1422–1426.

    Article  CAS  Google Scholar 

  34. Yang XJ, Lecksell K, Short K, Gottesman J, Peterson L, Bannow J et al. Does long-term finasteride therapy affect the histologic features of benign prostatic tissue and prostate cancer on needle biopsy? PLESS Study Group. Proscar Long-Term Efficacy and Safety Study. Urology 1999; 53: 696–700.

    Article  CAS  Google Scholar 

  35. Nickel JC, Downey J, Pontari MA, Shoskes DA, Zeitlin SI . A randomized placebo-controlled multicentre study to evaluate the safety and efficacy of finasteride for male chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis). BJU Int 2004; 93: 991–995.

    Article  CAS  Google Scholar 

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Author notes

  1. M Gacci and L Vignozzi: These authors contributed equally to this work.

Authors and Affiliations

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

    M Gacci, A Sebastianelli, M Salvi, C Giannessi, S Serni & M Carini

  2. Department of Clinical Physiopathology, University of Florence, Florence, Italy

    L Vignozzi & M Maggi

  3. Department of Urology, Sant’Andrea Hospital, University ‘La Sapienza’, Rome, Italy

    C De Nunzio & A Tubaro

  4. Endocrinology Unit, Maggiore-Bellaria Hospital, Bologna, Italy,

    G Corona & G Rastrelli

  5. Department of Pathology, University of Florence, Florence, Italy

    R Santi & G Nesi

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  1. M Gacci
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Correspondence to M Gacci or M Maggi.

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Gacci, M., Vignozzi, L., Sebastianelli, A. et al. Metabolic syndrome and lower urinary tract symptoms: the role of inflammation. Prostate Cancer Prostatic Dis 16, 101–106 (2013). https://doi.org/10.1038/pcan.2012.44

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  • DOI: https://doi.org/10.1038/pcan.2012.44

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