Abbreviations
and Acronyms
BLSA Baltimore Longitudinal
Study of Aging
BMI body mass index
BPH benign prostatic
hyperplasia
HPS Health Professionals
Follow-up Study
I-PSS International Prostate
Symptom Score
LUTS lower urinary tract
symptoms
NHANES National Health and
Nutrition Examination Survey
PCPT Prostate Cancer
Prevention Trial
* Correspondence: Division of Urology, University of California-San Diego, 200 West Arbor Dr.,
No. 8897, San Diego, California 92103-8897 (telephone: 619-543-2630; FAX: 619-543-6573; e-mail:
leparker@ucsd.edu).
Financial interest and/or other relationship
with American Medical Systems.
Financial interest and/or other relationship
with GlaxoSmithKline, Pfizer, Lilly/ICOS, SanofiAventis, Allergan and National Institute of Diabetes and Digestive and Kidney Diseases.
Financial interest and/or other relationship
with Sanofi, American Medical Systems, Envisioneering, Gen-Probe and Beckman.
S102
www.jurology.com
per year in direct health care expenditures are consumed exclusive of outpatient medication.1 The primary clinical
manifestation of BPH is the LUTS complex. As a result, BPH and LUTS remain inextricably interconnected in
the contemporary study of and treat-
0022-5347/13/1891-0102/0
THE JOURNAL OF UROLOGY
2013 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
http://dx.doi.org/10.1016/j.juro.2012.11.029
Vol. 189, S102-S106, January 2013
RESEARCH, INC.
Printed in U.S.A.
AND
S103
passes most established metrics of adiposity, including BMI, waist circumference and waist-to-hip ratio,
and involves 3 general categories of outcome, that is
prostate volume, BPH and LUTS (see table).
RESULTS
S104
Risk Factor
Referent
OR (95% CI)
3.52 (1.458.56)
2.38 (1.423.99)
2.00 (1.472.72)
1.79 (0.903.56)
1.30 (1.081.57)
1.41 (1.011.95)
1.48 (0.872.54)
1.13 (0.751.70)
1.08 (0.841.38)
* Defined as consistently severe urinary symptoms on I-PSS, initiation of medical therapy or BPH surgery.
DISCUSSION
Thus, obesity increases the risk of BPH by multiple
outcome measures. The public health import of this
observation is considerable. The prevalence of obesity continues to increase and obesity now affects
more than a third of American men.35 BPH also
affects a broad swath of the older male population,
which (like obesity) grows larger each year. By 2030,
20% of the American population will be 65 years old
or older, including more than 20 million men.36 The
confluence of these 3 trends, that is an increased
BPH risk with obesity, the obesity epidemic and the
rapid aging of the population, suggests the gathering of a perfect storm that will markedly swell the
S105
CONCLUSIONS
Obesity substantially increases the risk of BPH.
Since physical activity decreases BPH risk, these
observations support the development of novel strategies for BPH prevention and treatment targeted
toward adiposity, weight loss and lifestyle interventions.
REFERENCES
1. Wei JT, Calhoun E, Jacobsen SJ et al: Urologic
Diseases in America project: benign prostatic
hyperplasia. J Urol 2005; 173: 1256.
2. Engstrom G, Henningsohn L, Steineck G et al:
Self-assessed health, sadness and happiness in
relation to the total burden of symptoms from the
lower urinary tract. BJU Int 2005; 95: 810.
3. Engstrom G, Henningsohn L, Walker-Engstrom
ML et al: Impact on quality of life of different
lower urinary tract symptoms in men measured
by means of the SF 36 questionnaire. Scand
J Urol Nephrol 2006; 40: 485.
4. Taylor BC, Wilt TJ, Fink HA et al: Prevalence,
severity, and health correlates of lower urinary
S106
12. Joseph MA, Wei JT, Harlow SD et al: Relationship of serum sex-steroid hormones and prostate
volume in African American men. Prostate 2002;
53: 322.
13. Lee S, Min HG, Choi SH et al: Central obesity as
a risk factor for prostatic hyperplasia. Obesity
(Silver Spring) 2006; 14: 172.
14. Sarma AV, Jaffe CA, Schottenfeld D et al: Insulinlike growth factor-1, insulin-like growth factor
binding protein-3, and body mass index: clinical
correlates of prostate volume among Black men.
Urology 2002; 59: 362.
15. Freedland SJ, Platz EA, Presti JC Jr et al: Obesity,
serum prostate specific antigen and prostate size:
implications for prostate cancer detection. J Urol
2006; 175: 500.
16. Giovannucci E, Rimm EB, Chute CG et al: Obesity
and benign prostatic hyperplasia. Am J Epidemiol
1994; 140: 989.
17. Dahle SE, Chokkalingam AP, Gao YT et al: Body
size and serum levels of insulin and leptin in
relation to the risk of benign prostatic hyperplasia. J Urol 2002; 168: 599.
20. Burke JP, Rhodes T, Jacobson DJ et al: Association of anthropometric measures with the presence and progression of benign prostatic hyperplasia. Am J Epidemiol 2006; 164: 41.
33. Rohrmann S, Crespo CJ, Weber JR et al: Association of cigarette smoking, alcohol consumption and