Beyond The Abstract Physical Activity, Benign Prostatic Hyperplasia, And Lower Urinary Tract Symptoms

Main Category: Urology / Nephrology
Article Date: 19 Apr 2008 - 0:00 PDT

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UroToday.com - Our results suggest that moderate to vigorous physical activity may reduce the risk of benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) by as much as 25% relative to a sedentary lifestyle. Although the strength of the association appears to be greater with higher levels of activity, there was a non-significant trend toward a protective effect with even light physical activity. Adjustment for multiple confounders in the studies included in this analysis underscores the independence of the protective effect of physical activity on the BPH/LUTS complex.

The notion that physical activity and other modifiable lifestyle factors may alter the risks and severity of BPH and LUTS challenges traditional etiological paradigms and intimates the need for the development of new pathogenic models for the BPH/LUTS disease complex. The assumption that BPH and LUTS are relatively immutable consequences of aging driven by a combination of genetic predisposition, androgens, and estrogens underpins prior models. While genotype and hormones are important components, the relationship of physical activity with BPH/LUTS demands consideration of additional modulators of these processes.

It is possible that physical activity influences prostate growth pathways through alterations in hormone levels. However, we believe a more likely explanation is that physical activity exerts beneficial effects through improved cardiovascular health. Pre-clinical and observational data indicate that cardiovascular disease might promote BPH and LUTS. Men who suffer from components of the metabolic syndrome are more likely to have BPH and LUTS, as are men with heart disease. The metabolic syndrome is associated with systemic inflammation and oxidative stress, and inflammation potentially drives BPH. Thus, exercise which promotes weight loss, enhances vascular flow, normalizes serum lipid and lipoprotein concentrations, and prevents heart disease might mitigate the lower urinary tract manifestations of systemic cardiovascular disease.

In fact, the BPH/LUTS complex often occurs in association with erectile dysfunction (ED), which is strongly associated with cardiovascular disease. It is thus possible that the BPH/LUTS complex and ED share a common etiology related to cardiovascular disease. A shared cardiovascular etiology for the BPH/LUTS complex and ED would explain why the 2 conditions are associated with the same modifiable lifestyle factors, including obesity, diabetes, and hyperlipidemia. Moreover, increased physical activity has been associated with a lower risk of erectile dysfunction.

Written by J. Kellogg Parsons, MD, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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