Metabolic syndrome and diabetes for the urologist

The Effect of Metformin on Male Reproductive Function and Prostate: An Updated Review

Metformin is the first-line oral antidiabetic drug that shows multiple pleiotropic effects of anti-inflamation, anti-cancer, anti-aging, anti-microbia, anti-atherosclerosis, and immune modulation. Metformin's effects on men's related health are reviewed here, focusing on reproductive health under subtitles of erectile dysfunction (ED), steroidogenesis and spermatogenesis; and on prostate-related health under subtitles of prostate specific antigen (PSA), prostatitis, benign prostate hyperplasia (BPH), and prostate cancer (PCa). Updated literature suggests a potential role of metformin on arteriogenic ED but controversial and contradictory effects (either protective or harmful) on testicular functions of testosterone synthesis and spermatogenesis. With regards to prostate-related health, metformin use may be associated with lower levels of PSA in humans, but its clinical implications require more research. Although there is a lack of research on metform's effect on prostatitis, it may have potential benefits through its anti-microbial and anti-inflammatory properties. Metformin may reduce the risk of BPH by inhibiting the insulin-like growth factor 1 pathway and some but not all studies suggest a protective role of metformin on the risk of PCa. Many clinical trials are being conducted to investigate the use of metformin as an adjuvant therapy for PCa but results currently available are not conclusive. While some trials suggest a benefit in reducing the metastasis and recurrence of PCa, others do not show any benefit. More research works are warranted to illuminate the potential usefulness of metformin in the promotion of men's health.

Optimizing screening and management of cardiovascular health in prostate cancer: A review

In clinical practice, cancer management does not consistently encompass screening and identification of cardiovascular (CV) risk. The use of androgen deprivation therapy (ADT) in prostate cancer has been associated with increased CV risk and development of metabolic syndrome, necessitating identification of patients at risk in this population (e.g., those with pre-existing CV disease). A multidisciplinary team of Canadian physicians was assembled to develop a series of recommendations intended to identify patients who may benefit from optimal management of their CV disease and/or modification of cardiac risk factors. A key goal was the development of a simple screening tool for identification of patients with pre-existing CV disease. This simple and inclusive set of recommendations are intended for use within urology clinics to facilitate holistic approaches and simplify the management of patients.

High glucose induces the proliferation of prostatic cells via downregulating MRE11

The aim of the present study was to investigate the candidate genes and pathways associated with benign prostatic hyperplasia (BPH) and diabetes. In vitro experiments were performed using normal prostatic epithelial RWPE-1 and HPr-1 cells. The cell lines were treated with a high-glucose solution and MTS and bromodeoxyuridine assays were used to assess cell viability. Transcriptome sequencing was used to screen the candidate genes. The expression of candidate genes was further verified by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blotting. A meiotic recombination 11 (MRE11) overexpression vector was designed and transfected into RWPE-1 cells to verify the function of MRE11. A streptozotocin-induced diabetic rat model was established and rat MRE11 levels were determined by RT-qPCR and immunohistochemical staining. High concentrations of glucose resulted in RWPE-1 and HPr-1 cells with high viability. Transcriptome sequencing revealed that MRE11 was downregulated when RWPE-1 cells were exposed to high-glucose conditions. When MRE11 was overexpressed, cell viability decreased and cell apoptosis was induced under high-glucose conditions. Prostatic tissues from rats were collected and assessed; MRE11 expression was observed to be decreased, which was consistent with the in vitro cell experiments. BPH may be associated with diabetes, as MRE11 expression in prostatic cells was decreased when exposed to high-glucose conditions. Therefore, MRE11 may have potential as a biomarker for the early diagnosis of BPH and diabetes.

Metabesity and urological cancers

Metabolic syndrome is one of today's most important health problems. Due to increased prevalence of metabolic syndrome in society, studies done on this topic have increased in number. Although metabolic syndrome was previously considered to be important only for cardiovascular health, it has been learned that with new data, human health is compromised more thoroughly by metabolic syndrome and is also a danger to malignancy. As a result, a new definition in the form of metabesity has been introduced. In this review, available information on metabesity and urological cancers is presented.

Metabolic syndrome and benign prostatic hyperplasia: association or coincidence?

BACKGROUND

It has been suggested that individuals with metabolic syndrome (MetS) may be prone to developing benign prostatic hyperplasia (BPH), but the direction of causality remains uncertain. The objective of this cross-sectional study was to evaluate the association between BPH and MetS in men who were referred to surgery for BPH. We were interested in identifying the anthropometric, metabolic, and hormonal factors that potentially influence the risk of both conditions.

METHODS

The study was conducted on 128 males with BPH and 141 without BPH (the control group). Fasting glucose, insulin, lipid profiles, total and free testosterone, estradiol, sex-hormone binding protein (SHBG), dehydroepiandrosterone sulfate (DHEA-S), homeostasis model assessment (HOMA-IR) index, and lipid accumulation product (LAP) were all evaluated.

RESULTS

The prevalence of MetS was higher in patients with BPH than in the controls (58 vs. 41 %; P = 0.007). In comparison to the controls, patients with BPH had higher levels of cholesterol, low density lipoproteins, DHEA-S, insulin, and HOMA-IR, but lower levels of high-density lipoproteins (HDL), estradiol, and SHBG. The significant predictors of BPH were MetS (OR = 1.961), age (OR = 0.11), HDL (OR = 0.91), insulin (OR = 1.224), SHBG (OR = 0.98), and estradiol (OR = 0.978). Waist circumference and LAP inversely correlated with total and free testosterone and SHBG.

CONCLUSIONS

Our study confirmed the frequent coexistence of MetS and BPH. This association seems to be a consequence of the MetS-related metabolic derangements, changes in the sex-hormone milieu, and lowered SHBG levels.