ANDROGEN DEFICIENCY AND PROGRESSION OF BENIGN PROSTATIC HYPERPLASIA IN PATIENTS WITH METABOLIC SYNDROME: IS THERE ANY CONTROVERSY? (A LITERATURE REVIEW)

Abstract

The present review describes the mechanisms of benign prostatic hyperplasia (BPH) development in patients with metabolic syndrome (MS) and its association with androgen deficiency, which is frequently observed in these patients. We cover the data indicating that despite a reduced serum level of testosterone in patients with MS, they are more likely to be diagnosed with BPH, have more significant prostate enlargement, more rapid BPH progression, as well as deterioration of urination problems compared to patients of similar age without MS. The following factors are considered to trigger BPH in patients with MS: changes in the tissue metabolism of sex hormones with increased androgens and estrogens concentrations in the prostate gland despite the reduced serum androgen levels, relative prevalence of the estrogenic effects, chronic pelvic ischemia, stimulation of prostate cells proliferation due to the elevated insulin level and the increased secretion of growth factors, and developing chronic low-intensity inflammation. Specific features of BPH pathogenesis in individuals with MS suggest a correction of therapeutic approaches to BPH in such cases, because conventional therapy in patients with BPH and MS is less effective than in patients with BPH only.

Keywords

• metabolic syndrome
• androgen deficiency
• benign prostatic hyperplasia
• pathogenesis
• chronic ischemia
• insulin resistance
• chronic low-intensity inflammation