Race/Ethnicity, Obesity, Health Related Behaviors and the Risk of Symptomatic Benign Prostatic Hyperplasia: Results From the Prostate Cancer Prevention Trial

University of Texas at San Antonio, San Antonio, Texas, United States
The Journal of Urology (Impact Factor: 3.75). 05/2007; 177(4):1395-400; quiz 1591. DOI: 10.1016/j.juro.2006.11.065
Source: PubMed

ABSTRACT We examined risk factors for incident symptomatic benign prostate hyperplasia in 5,667 Prostate Cancer Prevention Trial placebo arm participants who were free of benign prostatic hyperplasia at baseline.
During 7 years benign prostatic hyperplasia symptoms were assessed annually using the International Prostate Symptom Score and benign prostatic hyperplasia treatment was assessed quarterly by structured interview. Total benign prostatic hyperplasia was defined as receipt of treatment or report of 2 International Prostate Symptom Score values greater than 14. Severe benign prostatic hyperplasia was defined as treatment or 2 International Prostate Symptom Score values of 20 or greater. Weight and body circumferences were measured by trained staff and demographic health related characteristics were collected by questionnaire. Cox proportional hazards models were used to calculate the covariate adjusted relative hazards of benign prostatic hyperplasia developing.
The incidence of total benign prostatic hyperplasia was 34.4 per 1,000 person-years. The risk of total benign prostatic hyperplasia increased 4% (p <0.001) with each additional year of age. Risks for total benign prostatic hyperplasia were 41% higher for black (p <0.03) and Hispanic men (p <0.06) compared to white men, and for severe benign prostatic hyperplasia these increases were 68% (p <0.01) and 59% (p <0.03), respectively. Each 0.05 increase in waist-to-hip ratio (a measure of abdominal obesity) was associated with a 10% increased risk of total (p <0.003) and severe (p <0.02) benign prostatic hyperplasia. Neither smoking nor physical activity was associated with risk.
Black race, Hispanic ethnicity and obesity, particularly abdominal obesity, are associated with increased benign prostatic hyperplasia risk. Weight loss may be helpful for the treatment or prevention of benign prostatic hyperplasia.

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    • "WHR provides an estimate of abdominal obesity (Wajchenberg, 2000), and a value greater than 0.9 is generally considered obese (Dobbelsteyn et al, 2001). It is now well known that abdominal obesity is associated with an increased risk of heart disease and diabetes, but recent studies have also looked into its relationship with prostate health (Gong et al, 2007; Hsing et al, 2007; Kristal et al, 2007). One study involving men in China found that those in the highest quartile of WHR had an almost 3-fold increased risk of prostate cancer (Hsing et al, 2001). "
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    • "For example, the study by Giovannucci et al of 25,892 men in the Health Professional Follow Up Study found a strong association between obesity and increased LUTS (Giovannucci et al, 1994). Analysis of the PCPT trial also demonstrated increased LUTS in men with higher WHR (Kristal et al, 2007) and a study of Korean men found that waist circumference was positively associated with increased LUTS (Lee et al, 2009a, b). A small study of 68 men with BPH found an association between obesity and prostate volume but not worse symptoms, although this was an underpowered study compared to those discussed previously (Soygur et al, 1996). "
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    • "While these factors are important contributors, modifiable risk factors of cardiovascular disease are also linked to BPH and LUTS. Obesity [2] [3], elevated fasting plasma glucose [2] [4], diabetes [2] [5] [6], dyslipidemia [7] [8], and the metabolic syndrome [7] [9] may all significantly increase the risks of BPH and LUTS. Since cardiovascular risk factors potentially contribute to BPH and LUTS pathogenesis, it is plausible that factors that protect against cardiovascular disease may also protect against BPH and LUTS. "
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