The correlation between metabolic syndrome and prostatic diseases

Low 25-OH vitamin D is associated with benign prostatic hyperplasia

PURPOSE

We tested the hypothesis that low vitamin D is associated with benign prostatic hyperplasia. We also studied whether body composition, sex hormones, serum sex hormone-binding globulin, albumin corrected serum calcium, adiponectin and lipid status are associated with benign prostatic hyperplasia.

MATERIALS AND METHODS

We investigated 184 representative, randomly selected men 72 to 76 years old enrolled in the Gothenburg arm of the Osteoporotic Fractures in Men Study (MrOS). Men with a history of prostate cancer, prostate operation or medication for benign prostatic hyperplasia were excluded from study, leaving 155 available for analysis. A cross-sectional study was performed in which benign prostatic hyperplasia measured by total prostate volume was related to clinical, anthropometric, endocrine and metabolic factors on univariate and multivariate analyses with regression models.

RESULTS

Median prostate volume was 40 ml. In multivariate models only 25-OH vitamin D, albumin corrected serum calcium, serum sex hormone-binding globulin and high density lipoprotein cholesterol were significantly and inversely associated with large prostate glands.

CONCLUSIONS

The current report adds 4 independent factors associated with benign prostatic hyperplasia, including low 25-OH vitamin D, serum calcium, sex hormone-binding globulin and high density lipoprotein cholesterol.

Influence of body mass index on Benign Prostatic Hyperplasia-related complications in patients undergoing prostatectomy

Objectives

To examine the link between increased body mass index and benign prostatic hyperplasia (BPH) related complications, namely: acute urinary retention (AUR), Bladder stones and Bladder diverticula.

Material and methods

Patients: We reviewed the medical records of BPH patients who underwent prostatectomy over three years period from 2010–2012. Prostatectomy was either done in the gold standard transurethral resection of the prostate (TURP) or using green light laser selective photo-vaporization (PVP). Age, PSA, Prostate Volume (PV) as measured by ultrasonography, patients’ weight & height, BPH related complications mainly AUR, bladder stones, and bladder diverticula were all taken in account. The BMI was calculated as weight in kg divided by square height in meters. The BMI was divided in 4 categories according to WHO classification: underweight if BMI ≤18.50 kg/m2; normal weight if BMI = 18.50-24.9 kg/m2; overweight: BMI ≥25 kg/m2; and obese BMI if ≥30 kg/m2. Statistical analysis: done using the SPSS package version 16. Chi-square test was used for comparison between groups where p-value was considered significant if <0.05 and ANOVA test was used for comparison between multiple variables.

Results

197 patients were included in this study, of those 95(48%) underwent TURP and 102(52%) underwent PVP. The two groups were found to be similar in mean age and PSA, and significantly different in prostate volume and operating room (O.R.) time.

Conclusions

Although the mean weight for patients undergoing prostatectomy in this study was in the overweight range, yet only 59/197(30%) patients with increased BMI presented with AUR. In this particular cohort of patients undergoing prostatectomy there was no significant differences in the development of AUR, bladder stone and diverticulum formation between patients with increased BMI (overweight and obese) and those with normal BMI. Further studies are recommended to explore the influence of increased BMI on BPH-related complications.

Relationship between Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia and Metabolic Syndrome in Korean Men

PURPOSE

To investigate any associations between lower urinary tract symptoms (LUTS)/benign prostate hyperplasia (BPH) and metabolic syndrome (MetS).

MATERIALS AND METHODS

In all, 1,224 male police officers in their 50s who had participated in health examinations were included. LUTS/BPH was assessed by serum prostate-specific antigen, International Prostate Symptom Score (IPSS), transrectal ultrasonography, maximum urinary flow rate (Q max), and postvoid residual urine volume (PVR). In addition, testosterone was also examined. The MetS was defined using NCEP-ATP III guidelines. We used the multiple linear regression test and logistic regression analyses to examine the relationships.

RESULTS

MetS was diagnosed in 29.0% of participants. There was no significant difference in the percentage of cases of BPH (IPSS >7, Q max <15 ml/sec, and prostate gland volume ≥ 20 ml) (14.2% in the non-MetS group vs. 17.2 in the MetS group; p value=0.178). The total IPSS score and the Q max were not significantly different. The prostate volume and PVR were significantly greater in the subjects with MetS. After adjusting for age and testosterone, the presence of MetS was not associated with BPH (multivariate odds ratio, 1.122; 95% confidence interval, 0.593~2.120). Additionally, MetS was not related to IPSS (Beta, -0.189; p value=0.819), prostate volume (Beta, 0.815; p value=0.285), Q max (Beta, -0.827; p value=0.393), or PVR (Beta, 0.506; p value=0.837).

CONCLUSIONS

According to our results, the MetS was not clearly correlated with LUTS/BPH in Korean men in their 50s.

Patients with metabolic syndrome and widespread high grade prostatic intraepithelial neoplasia are at a higher risk factor of prostate cancer on re-biopsy: a prospective single cohort study

OBJECTIVES

To test the hypothesis that patients with widespread high grade prostatic intra epithelial neoplasia (wHGPIN) and metabolic syndrome (MetS) are at a higher risk of prostate cancer (PCa) at a repeat biopsy.

METHODS AND MATERIALS

We prospectively evaluated 161 patients submitted from December 2004 to December 2011 to prostate rebiopsy after a initial diagnosis of HGPIN in a tertiary academic center. A 12 core biopsy template was used for all the biopsies. Rebiopsy was performed six months after the initial biopsy independently from PSA level and the DRE finding. wHGPIN was defined as≥4 biopsy cores involved. MetS was defined according to the National Cholesterol Education Program's Adult Treatment Panel III criteria.

RESULTS

Overall, 64 patients (39.7%) presented wHGPIN and 97 isolated HGPIN (60.3%). MetS was found in 63 patients, 39.1% of the whole population. Out of them 16 (25.3%) and 47 (74.7%) patients had a diagnosis of isolated and wHGPIN (P = 0.001). PCa detection rate at repeat biopsy was significantly higher in patients with MetS and wHGPIN than in those with wHGPIN and no MetS (57.4% Vs 23.5%; P = 0.016). A logistic regression model confirmed that wHGPIN and MetS are independent risk factors of prostate cancer diagnosis (respectively: Odds ratio (OR) = 4.187, 95%CI: 1.65-10.57 p = 0.002 and OR=3.603, 95%CI: 1.41-9.19, p = 0.007).

CONCLUSION

Patients with MetS and wHGPIN are at a higher risk of PCa, therefore performing a new prostate biopsy in those patients should be recommended.

The effect of metabolic syndrome upon the success of varicocelectomy

We aimed to investigate the impact of metabolic syndrome (MetS) on the varicocele treatment. 101 patients underwent spermatic vein ligation between 2007 and 2010 were retrospectively analyzed. Those patients were divided into two groups as without (n: 56, Group 1) or with MetS (n: 48, Group 2). All the patients underwent left microsurgical subinguinal spermatic vein ligation. Groups were compared by the improvement on sperm parameters and spontaneous pregnancy rates at a mean of 19 (±4) months followup. When sperm parameters were compared postoperatively, the significant improvement in total sperm count, motile sperm count percentage, and normal sperm percentage was reported. The groups were compared to each other and the improvement seemed significantly better in Group 1. There was no statistically significant improvement difference in the normal sperm percentage between groups. Spontaneous pregnancy rate after two years was 45% in Group 1 and 34% in Group 2 (P < 0.05). Patients with MetS and varicocele improved after surgery, but not as well as the similar group without MetS. This may help to show that MetS can be a factor for male infertility.

Differences in obesity measures and selected comorbidities in former National Football League professional athletes

OBJECTIVE

To assess the accuracy of body mass index (BMI) as a measure of obesity compared with percent body fat (%BF) directly measured by dual energy x-ray absorptiometry among retired football players.

METHODS

The level of agreement between BMI and %BF as measures of obesity was assessed by sensitivity, specificity, and the kappa statistic among 129 retired football players. Logistic regression was used to investigate the association between obesity and selected comorbidities.

RESULTS

Using BMI 30 kg/m or higher to identify obesity had poor specificity (0.36): 87 of 129 subjects were classified as obese, yet only 13 were truly obese based on %BF. Although BMI did not reliably indicate true %BF-obesity, BMI-obesity was significantly correlated with lineman position (P < 0.0001), years played (P = 0.03), and obstructive sleep apnea (P = 0.0005).

CONCLUSIONS

Percent body fat measured by dual energy x-ray absorptiometry provides a more accurate measure of obesity than does BMI among retired football players.

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

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 cm(3) (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 (Q(max)): 8.6 vs 10.1, P = 0.008 and average flow rate (Q(ave)): 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.

Office evaluation of male patients with lower urinary tract symptoms

Lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) are one of the most common urologic disorders in men. Accurate history-taking and focused physical examination allows us to diagnose the majority of cases. A better understanding of risk factors helps us tailor our treatment and predict outcomes more accurately. Population studies are crucial in our understanding of LUTS/BPH natural history. Temporary prostatic urethral stents that are used for the management of urinary retention may also be used for evaluation of patients with detrusor hypo-contractility. The use of ultrasound to measure intravesical prostatic protrusion (IPP) and the Doppler study for prostate capsular artery resistive index are promising. Near-infrared spectroscopy (NIRS) examines the tissue oxygenation that may be affected by bladder outlet obstruction. The mathematical algorithm needs some fine-tuning, and its reproducibility is debatable. Serum and urinary biomarkers may help us to diagnose the disorder, and more effectively monitor patients' response to therapy. Among all, IPP is clinically more applicable at this time.

Prostate cancer in patients with metabolic syndrome is associated with low grade Gleason score when diagnosed on biopsy

Purpose

Studies on the relationship of metabolic syndrome (MS) and prostate cancer are controversial. We evaluated the association between MS and prostate cancer characteristics in patients who underwent transrectal ultrasound-guided prostate biopsy.

Materials and Methods

From October 2003 to May 2011, patients with a prostate-specific antigen (PSA) value≥4 ng/ml or abnormal digital rectal examination (DRE) result underwent transrectal ultrasound-guided prostate biopsy. MS was diagnosed according to the Adult Treatment Panel III. Clinicopathologic factors including PSA, DRE, prostate volume, age, waist circumference, body mass index (BMI), lipid profiles, fasting blood sugar level, and MS were considered for analysis.

Results

Three hundred fifty-four patients were enrolled (mean age, 68.86±8.95 years; mean PSA, 13.97±20.42 ng/ml). Seventy-five patients (21.2%) had MS and 90 patients (25.4%) were diagnosed as having prostate cancer, including 27 (30%) with MS and 63 (70%) without MS. Total PSA value and prostate volume were significant predictors for prostate cancer. However, MS and BMI were not significantly related to increased cancer risk. Prostate cancer patients with MS had significantly lower Gleason scores (average, 6.63±1.92) than did prostate cancer patients without MS (average, 7.54±1.71; p=0.029).

Conclusions

Presence of MS was associated with a significantly decreased risk of high-grade prostate cancer. A larger, prospective, multicenter investigation is mandatory to clarify the relationship between MS and prostate cancer.

PPARγ isoforms differentially regulate metabolic networks to mediate mouse prostatic epithelial differentiation

Recent observations indicate prostatic diseases are comorbidities of systemic metabolic dysfunction. These discoveries revealed fundamental questions regarding the nature of prostate metabolism. We previously showed that prostate-specific ablation of PPARγ in mice resulted in tumorigenesis and active autophagy. Here, we demonstrate control of overlapping and distinct aspects of prostate epithelial metabolism by ectopic expression of individual PPARγ isoforms in PPARγ knockout prostate epithelial cells. Expression and activation of either PPARγ 1 or 2 reduced de novo lipogenesis and oxidative stress and mediated a switch from glucose to fatty acid oxidation through regulation of genes including Pdk4, Fabp4, Lpl, Acot1 and Cd36. Differential effects of PPARγ isoforms included decreased basal cell differentiation, Scd1 expression and triglyceride fatty acid desaturation and increased tumorigenicity by PPARγ1. In contrast, PPARγ2 expression significantly increased basal cell differentiation, Scd1 expression and AR expression and responsiveness. Finally, in confirmation of in vitro data, a PPARγ agonist versus high-fat diet (HFD) regimen in vivo confirmed that PPARγ agonization increased prostatic differentiation markers, whereas HFD downregulated PPARγ-regulated genes and decreased prostate differentiation. These data provide a rationale for pursuing a fundamental metabolic understanding of changes to glucose and fatty acid metabolism in benign and malignant prostatic diseases associated with systemic metabolic stress.

Diabetes, insulin resistance, and metabolic syndrome in horses

Analogous to the situation in human medicine, contemporary practices in horse management, which incorporate lengthy periods of physical inactivity coupled with provision of nutritional rations characterized by inappropriately high sugar and starch, have led to obesity being more commonly recognized by practitioners of equine veterinary practice. In many of these cases, obesity is associated with insulin resistance (IR) and glucose intolerance. An equine metabolic syndrome (MS) has been described that is similar to the human MS in that both IR and aspects of obesity represent cornerstones of its definition. Unlike its human counterpart, identification of the equine metabolic syndrome (EMS) portends greater risk for development of laminitis, a chronic, crippling affliction of the equine hoof. When severe, laminitis sometimes necessitates euthanasia. Unlike the human condition, the risk of developing type 2 diabetes mellitus and many other chronic conditions, for which the risk is recognized as increased in the face of MS, is less likely in horses. The equine veterinary literature has been replete with reports of scientific investigations regarding the epidemiology, pathophysiology, and treatment of EMS.