Metabolic syndrome and diabetes for the urologist

Abstract

Type2diabeteshasanumberofknowurologicalconsequences. Epidemiologicandclinicaldatasuggestalinkbetweenmetabolic syndromeandprostaticdiseases,suchasbenignprostatichyperplasia (BPH)andprostatecancer.Recentstudieshaveidentifiedmetforminas aviabletreatmentforpatientswithtype2diabetesandprostatecancer.M etabolic syndrome comprises a constellation of metabolic abnormalities that are associated with an increased risk of cardiovascular (CV) disease, type 2 diabetes, CV-specific mortality, and all-cause mortality.1,2 The definition of metabolic syndrome varies according to different sources, but generally comprises a series of factors involving insulin resistance, increased body weight, increased lipid levels, high blood pressure and impaired glucose levels (Table 1). [3][4][5][6][7] The prevalence of metabolic syndrome in Canada is estimated at 19%.8 Dietary excess and a sedentary lifestyle are thought to contribute to the development of metabolic syndrome in genetically susceptible individuals.The development of diabetes follows a series of stages, beginning with insulin resistance in peripheral tissues, resulting in glucose intolerance. At this stage, a postprandial rise in glucose may be the only sign of metabolic disturbance. With increased insulin resistance, the patient reaches a state of hyperinsulinemia combined with hyperglycemia -a stage that is often referred to as "pre-diabetes," during which the cells become increasingly starved for energy. During the hyperinsulinemic phase of type 2 diabetes, glucose levels rise above safe levels. Finally, during the burnout phase, beta-cells are no longer able to produce insulin. Insulin resistance occurs years before the onset of type 2 diabetes, due to genetic factors as well as environmental factors, such as sedentary lifestyle, pregnancy, nutrient intake (quantity and quality), puberty and aging. The net result is adiposity, impaired B-cell function, and impaired insulin action.Type 2 diabetes can result in a number of urological consequences. Renal consequences may include kidney stones, pyelonephritis/inflammation or chronic renal failure. In the bladder, urinary tract infections or cystopathy/retention may develop. Infertility, andropause and erectile dysfunction are also known urological consequences of type 2 diabetes. Recent epidemiologic and clinical data suggest a link between metabolic syndrome and prostatic diseases, such as benign prostatic hyperplasia (BPH) and prostate cancer. 10Many of the hormones, growth factors, cytokines and other mediators associated with obesity and the metabolic syndrome enable crosstalk between macrophages, adipocytes, endothelial cells and epithelial cells, which is implicated in carcinogenesis (including growth signaling, inflammation, and vascular alterations).11 A recent study at the University of Toronto found that men with 3 or more components of the metabolic syndrome had a 38% higher odds of being diagnosed with prostate cancer than men with no risk factors.12 These men also had a 52% higher odds of being diagnosed ...

The Effect of Metformin on Male Reproductive Function and Prostate: An Updated Review

“…Metabolic syndrome and its components of obesity, hyperinsulinemia, T2DM, dyslipidemia, and hypertension are significantly associated with BPH [ 89 90 91 92 93 ]. Therefore, metformin may not only reduce the risk of BPH via a direct effect on the prostate tissue, it may also act through indirect effects by correcting the metabolic dysregulations in the various components of metabolic syndrome.…”

Tasa de recurrencia del cáncer de próstata localizado después de la prostatectomía radical según la clasificación de riesgo de D'amico, en un hospital terciario de referencia: estudio de asociación

“…It was observed that the average age was 65.3 ± 5.91 years, similar to the reported in other studies (63-68 years) [16][17][18] . The main comorbidities were also evaluated, being type 2 diabetes mellitus (15.74%) and arterial hypertension (29.63%) the most frequent; considering that the metabolic syndrome is associated in different studies to increasing risk of prostate cancer 19 .…”

Optimizing screening and management of cardiovascular health in prostate cancer

“…Metformin is a biguanide drug used for treatment of type 2 diabetes. Metformin is believed to modify metabolism by inhibiting oxidative phosphorylation and thereby generating energetic stress in the liver 27 . Since early-stage prostate cancer predominantly relies on the oxidative phosphorylation pathway for energy generation, this effect may be potentially useful in management of early disease.…”