The Link Between BPH and Diabetes

The prostate is a gland that sits underneath the bladder in those with male reproductive organs. 

It is approximately the size of a walnut. It encircles the urethra, which is the tube that carries urine out of the body.

If the prostate gets new growth, then the question becomes: is this growth benign or cancerous? This is usually determined through a prostate biopsy

If the growth is benign, then this is benign prostatic hyperplasia (BPH). Since the prostate is enlarged in BPH, it can compress the urethra and cause urinary problems.

But is there a link between BPH and diabetes? Let’s find out.

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More and more evidence is showing that diabetes significantly increases the risk of benign prostatic hyperplasia. It also increases the risk of lower urinary tract symptoms in general. Hyperglycemia and insulin resistance increase risk as well. People with type 2 diabetes were found to have larger prostate glands.

Why is this? There are a few theories floating around. 5a-DHT has a role in the physiological function of the beta cells in the pancreas. Finasteride and dutasteride are often used in the treatment of benign prostatic hyperplasia. They inhibit enzymes called 5a-reductases. 

This is in an effort to reduce the biosynthesis of 5a-DHT. This can cause a form of tissue-specific androgen deficiency, but can contribute to various pathophysiological conditions. This includes insulin resistance and type 2 diabetes.

Some other theories of why patients with diabetes are at higher risk of developing benign prostatic hyperplasia include the following:

  • Increased sympathetic tone

  • Insulin and related factors stimulating prostate growth

  • Alterations in sex steroid hormone expression

  • Induction of systemic inflammation

  • Oxidative stress

Experts also say that metabolic disturbances such as prediabetes and metabolic syndrome (which involves diabetes and heart disease and a higher risk of myocardial infarction) could play a role in the development of benign prostatic hyperplasia. 

One explanation for this could be the insulin-like growth factor (IGF) axis and IGF binding proteins. Researchers have found that higher expression levels of IGF binding proteins predict higher prostate volume.

What the studies say

Olmsted County Study

One systematic review looked at both the Olmsted County Study of Urinary Symptoms and Health Status as well as the Flint Men’s Health Study. They combined the data for a total of 2484 patients in the sample.

6.8% of patients reported a history of diabetes. Researchers found that patients with diabetes had more irritative lower urinary tract symptoms and nocturia (waking to urinate at night). These patterns were consistent, no matter the patient’s race, age, body mass index, or socio-economic status.

Systematic review

Another systematic review looked at studies that were published from 1990 onwards. They searched the MEDLINE database of the National Library of Medicine. 

Results showed that there is possibly a common pathogenic mechanism linking diabetes and prostate growth (BPH).

However, the specific pathway involved in both conditions is poorly researched. This is why the exact relationship between benign prostatic hyperplasia and diabetes is not entirely clear.

Journal of Urology study

A study from the Journal of Urology in June of 2000 showed that the symptoms of benign prostatic hyperplasia tend to be worse in those with diabetes.

This study looked at records of patients undergoing drug treatment for benign prostatic hyperplasia. The sample included 1290 men with diabetes and 8566 without.

Researchers compared symptoms of benign prostatic hyperplasia before and after drug treatment. They found that those with diabetes had more symptoms and a slower urine flow rate.

Moreover, they also found that diabetic men have symptoms as severe as non-diabetic patients eleven years older. They also had a urine flow rate similar to men without diabetes who were seven years older than them.

California Men’s Health Study

Another systematic review looked at questionnaires and clinical data from two large multi-ethnic studies. These were the California Men’s Health Study and the Research Program in Genes, Environment and Health.

Researchers found that type 2 diabetes is associated with prevalent lower urinary tract symptoms. This association was even stronger in men with type 2 diabetes who were on pharmaceutical diabetes treatment and had diabetes for a longer time.

Dr. J. Kellogg Parsons study

Dr. J. Kellogg Parsons is from the University of California at San Diego. They studied the association between benign prostatic hyperplasia and other factors. These factors included obesity, blood glucose concentration, and diabetes. 

They looked at 422 men between the ages of 27 and 84 and used MRI technology to measure prostate size.

They found that 91 of these men (22 percent) had an enlarged prostate. Moreover, they also found that blood glucose concentration was associated with a risk of prostate enlargement. 

In fact, patients with high glucose had three times the risk of having an enlarged prostate. Patients with diabetes were more than double as likely to have an enlarged prostate than their peers who did not have diabetes.

Does diabetes increase your risk of prostate issues?

Prostate Cancer and PSA

Recent studies show that there is an association between antidiabetic medications and the incidence of cancer. For example, the antidiabetic drug metformin has shown positive effects in prostate tumors. 

There is certainly a strong association between diabetes and cancer. Some of these possible links include high insulin levels in the blood, hyperglycemia, and fat-induced chronic inflammation.

Moderate glucose concentration in the blood can influence the growth of prostate cancer cells. Androgen signaling is a major driver for the progression of prostate cancer risk factors. 

In diabetes, there is elevated androgen receptor signaling and activity. This is because of altered insulin IGF-1 receptors. It’s also due to lower levels of estrogen receptor ligands, which are protective against prostate cancer.

Several studies do show that people with diabetes have a lower incidence of being prostate cancer patients. However, many researchers suggest this could be skewed. 

This is because patients with diabetes have lower PSA (prostate-specific antigen) levels compared to those without diabetes. This means that patients with diabetes may not have less cancer, but simply that prostate cancer detection isn’t able to happen through PSA test prostate cancer screening.

Diabetes is significantly associated with lower serum PSA levels. Researchers do say that biological differences may actually put people with diabetes at decreased prostate cancer incidence, though.

As of recent years, PSA level thresholds have been lowered. Because of this, rates of low-grade prostate tumors have increased among people with diabetes.

Diabetes is associated with high-grade, aggressive prostate cancer. This is because the lower serum testosterone and PSA levels that we see in patients with diabetes cause the cancer to be more advanced at diagnosis.

BPH

Benign prostatic hyperplasia medications can also have an impact on the development of diabetes mellitus. Insulin resistance appears in 25 to 60 percent of patients within three months of starting androgen deprivation therapy (hormone therapy for prostate cancer treatment). 

Long-term androgen deprivation therapy leads to a higher incidence of diabetes. The most common type of androgen deprivation therapy is GnRH agonists. Researchers think this could be related to certain cytokines, such as IL-6 and TNF-a.

Are there ways to lower your risk?

There are several ways to lower your risk of developing diabetes. This includes:

  • Losing weight

  • Decreasing alcohol consumption

  • Optimizing your vitamin D levels

You can also reduce your risk of developing diabetes by increasing physical activity and avoiding sedentary behaviors. This is because exercising increases insulin sensitivity. So, when you exercise, you don’t need as much insulin to keep your blood sugar levels in control.

One study found that moderate-intensity exercise increased insulin sensitivity by 51% in patients with prediabetes. Better yet, high-intensity exercise increased insulin sensitivity by 85%.

Several types of physical activity reduce blood sugar and help improve insulin resistance in patients with prediabetes, obesity, and those who are overweight. These include aerobic exercise, strength training, and high-intensity interval training.

Exercising at a higher frequency improves insulin response and function. One study found that people at higher risk of diabetes could achieve these benefits if they burn over 2000 calories per week with exercise.

You can also help lower your risk by improving your diet. Nutritional changes you can make include the following:

  • Cutting sugar and refined carbs out of your diet

  • Drink water as your primary beverage

  • Follow a low carb diet

  • Minimize your portion sizes

  • Eat a diet that is high in fiber

  • Minimize your intake of processed foods

If you eat foods that are high in sugar and other refined carbs, this can increase your risk of developing diabetes. This is because your body breaks these foods into glucose molecules in a rapid manner.

For decades, researchers have studied the link between diabetes and benign prostatic hyperplasia. Although they are not one hundred percent sure why these conditions are related, the theories above do hold some weight.

Conclusion

If you want to lower your risk of developing benign prostatic hyperplasia, it can help to reduce your risk of developing diabetes. You can do this by making healthy lifestyle changes.

Lose weight, quit smoking, lower your blood pressure and cholesterol levels. Improve your diet, increase physical activity, and decrease your alcohol consumption. Speak to a health care provider about taking vitamin D, curcumin, or berberine supplements.

If you already have benign prostatic hyperplasia and worry about your risk of developing type 2 diabetes, then speak to your health care provider. It’s important to be proactive, especially when your health is on the line.

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Books By Ben Ong: Prostate Health and Diabetes.

Sources

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  3. Miller, EA & Pinsky, PF. (2020). Examining the relationship between diabetes and prostate cancer through changes in screening guidelines. Cancer Causes Control. 31 (12), 1105-13. https://pubmed.ncbi.nlm.nih.gov/32970300/
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