The Role of Metabolic Syndrome in the Progression of Benign Prostatic Hyperplasia: A Systematic Review
Keywords:
Benign prostatic hyperplasia; metabolic syndrome; disease progression; lower urinary tract symptoms; insulin resistanceAbstract
Introduction: Benign prostatic hyperplasia (BPH) is highly prevalent in aging men. Metabolic syndrome (MetS) has been proposed as a modifiable risk factor for BPH progression, but evidence synthesis is lacking. This review evaluates the association between MetS and BPH progression.
Methods: A systematic search of PubMed, Scopus, and Web of Science (2010–2023) identified observational studies comparing BPH outcomes in men with versus without MetS. Inclusion criteria: adult males, diagnosed BPH, and at least one follow-up assessment of prostate volume, International Prostate Symptom Score (IPSS), or acute urinary retention. Quality was assessed using Newcastle-Ottawa Scale.
Results: Fifteen studies (n=18,450) met inclusion. Men with MetS had significantly larger mean prostate volume (difference +8.2 mL, 95%CI 4.1–12.3) and higher IPSS (mean difference 3.4 points, p<0.01). Hypertension and hyperglycemia were the strongest individual components associated with progression. Annual prostate growth rate was 2.1-fold higher in MetS patients.
Discussion: Chronic low-grade inflammation and insulin resistance likely drive prostatic stromal and epithelial proliferation. Heterogeneity in MetS definitions limited comparability. Most studies lacked standardized medication histories (e.g., alpha-blockers), potentially confounding results.
Conclusions: Metabolic syndrome is consistently associated with accelerated BPH progression. Screening for MetS in BPH patients and early lifestyle intervention may alter disease trajectory. Prospective interventional trials are warranted.
