Introduction: Inflammation is postulated to link obesity and benign prostatic hyperplasia (BPH). The role of inflammation and the prognostic significance of body mass index (BMI) was investigated in BPH patients. Subjects and Methods: Consecutive patients with histological BPH were identified from 1996 to 2005. Systemic inflammation was assessed by modified Glasgow Prognostic Score (mGPS) and local inflammation by Klintrup-Makinen criteria. Results: In 392 patients, BMI was associated with cardiovascular disease (p = 0.033), type 2 diabetes mellitus (p = 4.45 × 10-8), aspirin usage (p = 0.018) and failure of surgical treatment (p = 0.001). mGPS and Klintrup-Makinen scores were not associated with clinical variables or outcome measures. On multivariate analysis BMI was an independent predictor of time to failure of surgical management of BPH, HR 1.56 (95% CI 1.11-2.19), p = 0.010. Conclusions: The mGPS and Klintrup-Makinen scores were not associated with BMI in BPH patients. High BMI is associated with failure of surgical management of BPH. Preoperative weight loss should be strongly encouraged in these patients.

Keywords:
Benign prostatic hyperplasia, Body mass index, Inflammation, Lower urinary tract symptoms
1.
Berry SJ, Coffey DS, Walsh PC, Ewing LL: The development of human benign prostatic hyperplasia with age. J Urol 1984;132:474-479.
2.
Hammarsten J, Hogstedt B, Holthuis N, Mellstrom D: Components of the metabolic syndrome - risk factors for the development of benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 1998;1:157-162.
3.
Giovannucci E, Rimm EB, Chute CG, Kawachi I, Colditz GA, Stampfer MJ, Willett WC: Obesity and benign prostatic hyperplasia. Am J Epidemiol 1994;140:989-1002.
4.
Dahle SE, Chokkalingam AP, Gao YT, Deng J, Stanczyk FZ, Hsing AW: Body size and serum levels of insulin and leptin in relation to the risk of benign prostatic hyperplasia. J Urol 2002;168:599-604.
5.
Lee RK, Chung D, Chughtai B, Te AE, Kap-lan SA: Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms. BJU Int 2012;110:540-545.
6.
Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Weiss N, Goodman P, Antvelink CM, Penson DF, Thompson IM: Race/ethnicity, obesity, health-related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the Prostate Cancer Prevention Trial. J Urol 2007;177:1395-1400.
7.
Seim A, Hoyo C, Ostbye T, Vatten L: The prevalence and correlates of urinary tract symptoms in Norwegian men: the Hunt Study. BJU Int 2005;96:88-92.
8.
Lotti F, Corona G, Colpi GM, Filimberti E, Degli Innocenti S, Mancini M, Baldi E, Noci I, Forti G, Adorini L, Maggi M: Elevated body mass index correlates with higher seminal plasma interleukin-8 levels and ultrasonographic abnormalities of the prostate in men attending an andrology clinic for infertility. J Endocrinol Invest 2011;34:e336-e342.
9.
Parsons JK, Carter HB, Partin AW, Windham BG, Metter EJ, Ferrucci L, Landis P, Platz EA: Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab 2006;91:2562-2568.
10.
Roehrborn CG, McConnell JD, Lieber M, Kaplan S, Geller J, Malek GH, Castellanos R, Coffield S, Saltzman B, Resnick M, Cook TJ, Waldstreicher J: Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology 1999;53:473-480.
11.
McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW, Lepor H, McVary KT, Nyberg LM Jr, Clarke HS, Crawford ED, Diokno A, Foley JP, Foster HE, Jacobs SC, Kaplan SA, Kreder KJ, Lieber MM, Lucia MS, Miller GJ, Menon M, Milam DF, Ramsdell JW, Schenkman NS, Slawin KM, Smith JA: The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 2003;349:2387-2398.
12.
De Heredia FP, Gomez-Martinez S, Marcos A: Obesity, inflammation and the immune system. Proc Nutr Soc 2012;71:332-338.
13.
St Sauver JL, Sarma AV, Jacobson DJ, McGree ME, Lieber MM, Girman CJ, Nehra A, Jacobsen SJ: Associations between C-reactive protein and benign prostatic hyperplasia/lower urinary tract symptom outcomes in a population-based cohort. Am J Epidemiol 2009;169:1281-1290.
14.
Khoo J, Piantadosi C, Duncan R, Worthley SG, Jenkins A, Noakes M, Worthley MI, Lange K, Wittert GA: Comparing effects of a low-energy diet and a high-protein low-fat diet on sexual and endothelial function, urinary tract symptoms, and inflammation in obese diabetic men. J Sex Med 2011;8:2868-2875.
15.
Alokail MS, Al-Daghri NM, Al-Attas OS, Alkharfy KM, Sabico SB, Ullrich A: Visceral obesity and inflammation markers in relation to serum prostate volume biomarkers among apparently healthy men. Eur J Clin Invest 2011;41:987-994.
16.
Shafique K, Proctor MJ, McMillan DC, Qureshi K, Leung H, Morrison DS: Systemic inflammation and survival of patients with prostate cancer: evidence from the Glasgow Inflammation Outcome Study. Prostate Cancer Prostatic Dis 2012;15:195-201.
17.
Klintrup K, Makinen JM, Kauppila S, Vare PO, Melkko J, Tuominen H, Tuppurainen K, Makela J, Karttunen TJ, Makinen MJ: Inflammation and prognosis in colorectal cancer. Eur J Cancer 2005;41:2645-2654.
18.
Li MK, Garcia L, Patron N, Moh LC, Sundram M, Leungwattanakij S, Pripatnanont C, Cheng C, Chi-Wai M, Loi-Cheong N: An Asian multinational prospective observational registry of patients with benign prostatic hyperplasia, with a focus on comorbidities, lower urinary tract symptoms and sexual function. BJU Int 2008;101:197-202.
19.
Lee SH, Oh CY, Park KK, Chung MS, Yoo SJ, Chung BH: Comparison of the clinical efficacy of medical treatment of symptomatic benign prostatic hyperplasia between normal and obese patients. Asian J Androl 2011;13:728-731.
20.
Emberton M, Neal DE, Black N, Harrison M, Fordham M, McBrien MP, Williams RE, McPherson K, Devlin HB: The National Prostatectomy Audit: the clinical management of patients during hospital admission. Br J Urol 1995;75:301-316.
21.
Kramer G, Steiner GE, Handisurya A, Stix U, Haitel A, Knerer B, Gessl A, Lee C, Marber-ger M: Increased expression of lymphocyte-derived cytokines in benign hyperplastic prostate tissue, identification of the producing cell types, and effect of differentially expressed cytokines on stromal cell proliferation. Prostate 2002;52:43-58.
22.
Qayyum T, McArdle PA, Going JJ, Orange C, Seywright M, Aitchison MA, Edwards J: Is the presence or absence of tumour necrosis a significant predictor of survival in renal cell cancer? Urol Int 2012;88:79-83.
23.
Roxburgh CS, Salmond JM, Horgan PG, Oien KA, McMillan DC: Tumour inflammatory infiltrate predicts survival following curative resection for node-negative colorectal cancer. Eur J Cancer 2009;45:2138-2145.
24.
Lamb AD, Qadan M, Roberts S, Timlin H, Vowler SL, Campbell FM, Grigor K, Bartlett JM, McNeill SA: CD4+ and CD8+ T-lymphocyte scores cannot reliably predict progression in patients with benign prostatic hyperplasia. BJU Int 2011;108:E43-E50.
25.
Robert G, Descazeaud A, Nicolaiew N, Terry S, Sirab N, Vacherot F, Maille P, Allory Y, de la Taille A: Inflammation in benign prostatic hyperplasia: a 282 patients' immunohistochemical analysis. Prostate 2009;69:1774-1780.
26.
Selvin E, Paynter NP, Erlinger TP: The effect of weight loss on C-reactive protein: a systematic review. Arch Intern Med 2007;167:31-39.
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2012
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