The role of chronic inflammation, metabolic syndrome, and prostate microbiota in the pathogenesis of benign prostatic hyperplasia

Abstract

Benign prostatic hyperplasia (BPH) is one of the most common urological diseases leading to the development of lower urinary tract symptoms. Traditionally, the pathogenesis of BPH is associated with hormonal imbalance and the activity of 5-α-reductase, however, modern data indicate a significant role of chronic inflammation of the prostate gland, systemic metabolic disorders, combined by the concept of “metabolic syndrome”. The review of domestic and foreign scientific literature, including epidemiological, clinical and experimental studies on the relationship of BPH, is carried out./urinary tract symptoms, chronic prostatitis and metabolic syndrome (obesity, insulin resistance, dyslipidemia, hypertension, androgen deficiency). It has been established that the presence of metabolic syndrome and chronic prostatitis is associated with more frequent detection of BPH and marked disease progression. In patients with BPH on the background of metabolic syndrome, a significant increase in prostate volume, higher levels of prostate-specific antigen, and an accelerated annual increase in gland volume are recorded compared with patients without metabolic disorders. The components of metabolic syndrome are independent risk factors for severe urinary tract symptoms. The main pathogenetic mechanisms include chronic pelvic ischemia, hyperinsulinemia, imbalance of sex hormones and chronic sluggish inflammation. The effectiveness of drug and surgical treatment in this group of patients is reduced. Benign prostatic hyperplasia should be considered not as a local disease, but as a systemic metabolic disease of the age period. Various components of the metabolic syndrome and chronic inflammation of the gland independently accelerate the progression of BPH/urinary tract symptoms, which requires the personalization of therapy with mandatory correction of metabolic disorders to increase the effectiveness of treatment.