A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia

Abstract

We assessed the relation of plasma hormone levels and nonhormonal factors with subsequent occurrence of surgical treatment for benign prostatic hyperplasia (BPH) among participants in the Physicians' Health Study. Frozen plasma samples, collected at the study onset, were available for 320 men who developed surgically treated BPH up to 9 years later and for 320 age-matched controls. Plasma testosterone (T), dihydrotestosterone (DHT), androstenedione, estradiol (E2), and estrone (E1) were measured for each case-control pair. In unadjusted analyses, none of the hormones or hormone ratios were associated with BPH; for example, for T and E2 the odds ratios (OR) comparing the highest quintile (Q5) with the lowest (Q1) were 0.74 (95% CI = 0.42, 1.30) and 1.07 (95% CI = 0.51, 2.22), respectively. However, in multivariate analyses controlling diastolic blood pressure, exercise, alcohol, E1, and DHT:T ratio, we observed a strong trend for increasing risk across quintiles for E2 (Q5 vs. Q1 OR = 3.56, P trend = 0.009), and a weak inverse trend for E1 (Q5 vs Q1 OR = 0.51, P trend = 0.07). The excess risk associated with E2 was confined to men with relatively low androgen levels. Three nonhormonal factors previously suspected as risk factors were independently associated with surgical BPH in these data. The OR for a 1-mm Hg difference in diastolic blood pressure was 1.04 (95% CI = 1.01, 1.07). Alcohol use and infrequent exercise were inversely associated with risk of BPH surgery; however, risk estimates were not consistent across categories of exercise and alcohol frequency. Our results indicate that normal variation in circulating androgen levels does not influence development of BPH, but that variation in estrogen levels might be important.

Body mass index and risk of BPH: a meta-analysis

“…27,29,31,[33][34][35][36][37][38][39][40][42][43][44][45] When BPH and LUTS were combined, we observed that the BMI was associated with BPH or LUTS (Figure 1, OR ¼ 1.23, 95% CI 1.03-1.48) and the summary OR were similar in population-based casecontrol study, whereas the summary OR in cohort study and hospital-based case-control study showed no association between BMI and BPH/LUTS. Heterogeneity was detected (Po0.05) among all studies and in the subgroup of population-based case-control studies.…”

Lifetime occupational and recreational physical activity and risk of benign prostatic hyperplasia

“…[8][9][10][11] Inverse association emerged for both occupational and recreational PA and was consistently found in different strata of selected covariates. The strongest association emerged with occupational or recreational PA in young adulthood (~50% of risk reduction), but some protection was also found for high PA levels at ages 50-59 years (one-third reduction).…”

“…The most plausible mechanisms are related to the modulation of endogenous hormones, in particular androgens and estrogens. 9,15,16 Previous studies showed that androgens are involved in the development and maintenance of BPH, as supported by androgen receptor expression in the prostate epithelium. 17 High levels of PA have been reported to lower basal levels of circulating testosterone, which controls prostate growth 17,18 and BPH.…”

“…19 Different methods were used in different studies, considering the relation between PA and BPH, [8][9][10][11] which may, at least in part, be responsible of inconsistencies of results. In cohort studies including repeated measures of PA, however, recall of PA level in the past proved to be reliable.…”

“…The Physicians' Health Study, based on 320 cases, 9 included only information on leisure-time exercise and showed inconsistent inverse associations between BPH and PA across strata of exercise. In the ''Massachusetts Male Aging'' prospective study (198 cases), 10 an inverse association emerged between BPH and total PA at enrollment (median 9 years before diagnosis).…”