Overweight and obesity are risk factors for many health problems such as cardiovascular diseases, type 2 diabetes, high blood pressure, joint conditions, gallstones, and certain types of cancer among other issues.
Hereafter, we’ll discuss how obesity affects the health of the prostate, namely benign prostate enlargement and prostate cancer (PC). The aim is to educate and attract the attention of men to the adverse consequences that may have obesity on the male reproductive system in general and prostate health in particular.
Currently, prostate cancer is on the rise and so is obesity.
Only for the last five years, in the United States, registered PC cases have increased by 27% from 180,890 in 2016 to 248,530 in 2021.
The deaths from PC raised by 24% from 26,120 deaths in 2016 to 34,130 deaths in 2021.
Five years ago, an official forecast for PC was: 1 man in 9 will be diagnosed with prostate cancer during his lifetime. Now, it is 1 man in 8 already.
Don’t allow to be a part of these horrible statistics.
How does obesity work?
Currently, over 30% of American men are obese based on a body mass index (BMI) of >30, about two decades past, this figure was two times less.
Usually, you have an excessive body mass, not because of muscles but fat. Fat or how it called adipose tissue consists mostly of lipid-rich cells which are the energy storage of the body. It has been shown both on humans and animals that adipose tissue is a site where the high activity of enzyme aromatase is observed. Aromatase converts testosterone (T) a male hormone produced in the testicles and making you masculine, into estrogen, or the most common form of estrogen estradiol (E2). Although E2 is called a female sex hormone, it plays a crucial role in multiple functions, including reproductive, in men’s bodies as well. And it works perfectly as long as you did not gain extra weight. Obese men have more aromatase activity than normal, more T irreversibly converts into E2 disrupting their balance. Males with increasing obesity have on average twofold higher estrogen levels in both systemic circulation and locally in the prostate. And of course, these hormonal changes not only make a man more feminine affecting his body shape, sexual sphere, and even his social behavior but have a significant influence on prostate health as well.
BMI >30 has been found to correlate with higher prostate weight, prostate-specific antigen (PSA), and more aggressive prostate cancer (Goris Gbenou MC et al. 2016). BMI thus is an additional risk factor besides PSA.
How to measure obesity?
The amount of adipose tissue is connected to the level of both acute and chronic inflammation. (Fox C.S. et al. 2007), There are two types of fat:
- visceral or abdominal fat which is deposited on the internal organs in the abdominal cavity and
- subcutaneous or peripheral fat.
Studies show that it is visceral fat that contributes to inflammation in the body (Villaret A. et al. 2010).
Since BMI counts not only the amount of fat but the weight of muscles as well, often it cannot be used as a reliable criterion reflecting the real obesity rate. As an alternative waist circumference (WC) in determining visceral adiposity or central obesity has been proposed and successfully used in many studies. To correctly measure WC, place a tape measure around your torso, just in the middle between the last ribs and hipbones. Keep the tape not compressing the skin and measure your waist just after you breathe out. Central obesity can be diagnosed if WC is larger than 90 cm (40 in) in men and 80 cm (35 in) in women.
How does obesity affect BPH?
The results of all studies agree on one thing: obese men have a higher risk for benign prostatic hyperplasia (BPH) and worsened urinary symptoms. (Giovannucci E. et al. 1994; Lee S. et al. 2006; Wang H.H. et al. 2011). The greater the size of WC the larger the volume of the prostate and higher the values of prostate-specific antigen and International Prostate Symptom Score. All this shows the worsened lower urinary tract symptoms in obese men. (Lee R.K. et al. 2012).
Several mechanisms may help to link obesity and BPH. They all work together, contributing to the worsening of the BPH symptoms independently of each other.
- Visceral obesity may increase intra-abdominal pressure and bladder pressure, which in turn aggravate lower urinary tract symptoms related to BPH.
- Hormonal imbalance is another mechanism connecting obesity to BPH. Due to the high activity of the aromatase gene in adipose tissues and progressive conversion of testosterone to estradiol and androstenedione to estrone the ratio of estrogens to androgens increases. Besides, an increased estradiol production may suppress the Hypothalamic–pituitary-gonadal axis and result in a further decline in the T levels and the development of hypogonadism (reduction of testicular size) thus favorable in the development of BPH. (Williams G. 2012).
- Accumulation of inflammation and oxidative stress is one more mechanism of obesity and the BPH connection. (Sciarra A. et al. 2008). Visceral fat produces inflammatory cytokines leading to chronic inflammation and contributing to oxidative stress, thus making the prostate tissue favorable to BPH. The size of the prostate volume corresponds to the extent and severity of the inflammation.
How does obesity affect prostate cancer?
The results of all studies, with rare exceptions, show that obesity is a risk factor for the development of PC and especially, high-grade disease.
In a study by De Nunzio C. et al. (2013) 246 patients were diagnosed with PC, 136 of them had low-grade (Gleason score ≤ 6), and 110 high-grade cancer (Gleason score ≥ 7). The patients were categorized into two groups according to BMI and WC. Obesity with BMI ≥ 30 kg/m(2) and WC ≥ 102 cm was associated with PC diagnosis and high-grade disease.
The study by Irani J. et al. (2003) found that obese men had 2.5 times the risk of having PC.
The conclusions of the Korean study (Park J. 2014) sound the same as multiple other studies worldwide: “Obese men were younger, had a larger prostate. Obesity was associated with a higher risk of prostate cancer detection as an independent factor, including high-grade prostate cancer.”
The exact mechanisms of how obesity affects the development of prostate cancer have not been elucidated. However, based on the available data, scientists suggest that several possible mechanisms are involved, including:
- Insulin resistance,
- Imbalance of sex hormones (decreased serum testosterone and peripheral aromatization of androgen),
Obesity is known to promote insulin resistance. As a result, the level of insulin rises to maintain blood sugar control. Increased insulin upregulates aromatase activity and further increases serum estrogen levels. On the other hand, hyperinsulinemia also suppresses the synthesis of sex-hormone-binding globulin in the liver, which further increases the level of free or bioavailable estrogens in the blood. The increased estrogen/testosterone ratio has been linked with PC initiation and progression. (Di Zazzo E. et al. 2018).
If you are of middle age and noticed the first symptoms of low testosterone and accumulation of extra abdominal fat, it means that the lifestyle you are so used to is starting to work against you. Do not try to remedy the situation with medications, stimulants, or even dietary supplements. All of these can be deceiving, but will ultimately make your health worse. Stop, take a breath and calmly analyze what you can change in your life to avoid unpleasant health surprises in the future. It’s time to take measures until it’s not too late. What kind of measures?
- Change your diet: give up junk food, include more organic vegetables, fruits, nuts, healthy fats, more seafood, less dairy, red meat, smoked products, flour products, cookies, soda, and sweet beverages.
- More physical activity. Even if you get tired of physical activity at work, not to mention a sedentary lifestyle, often such tiredness is due to the monotony of work and mental fatigue. Two to three times a week, do a workout to give your body a good shake, which includes all major muscle groups: muscles of the legs, arms, abs, back, pelvis, and neck.
- Get good sleep. It would seem that nothing is required of you here, but often this can be the most difficult task. If you sleep well for 7 hours a day, this means that your body successfully copes with all the stresses in your life.
- Goris Gbenou MC, Peltier A, Schulman CC, Velthoven RV. Increased body mass index as a risk factor in localized prostate cancer treated by radical prostatectomy. Urol Oncol. 2016;34:254. e1–6.
- Fox C.S., Massaro J.M., Hoffmann U., Pou K.M., Maurovich-Horvat P., Liu C.Y. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39–48.
- Villaret A., Galitzky J., Decaunes P., Esteve D., Marques M.A., Sengenes C. Adipose tissue endothelial cells from obese human subjects: differences among depots in angiogenic, metabolic, and inflammatory gene expression and cellular senescence. Diabetes. 2010;59:2755–2763.
- Giovannucci E., Rimm E.B., Chute C.G., Kawachi I., Colditz G.A., Stampfer M.J. Obesity and benign prostatic hyperplasia. Am J Epidemiol. 1994;140:989–1002.
- Lee S., Min H.G., Choi S.H., Kim Y.J., Oh S.W., Kim Y.J. Central obesity as a risk factor for prostatic hyperplasia. Obesity. 2006;14:172–179.
- Wang H.H., Hsieh C.J., Lin K.J., Chu S.H., Chuang C.K., Chen H.W. Waist circumference is an independent risk factor for prostatic hyperplasia in Taiwanese males. Asian J Surg. 2011;34:163–167.
- Williams G. Aromatase up-regulation, insulin, and raised intracellular oestrogens in men, induce adiposity, metabolic syndrome, and prostate disease, via aberrant ER-alpha and GPER signalling. Mol Cell Endocrinol. 2012;351:269–278.
- Sciarra A., Mariotti G., Salciccia S., Autran Gomez A., Monti S., Toscano V. Prostate growth and inflammation. J Steroid Biochem Mol Biol. 2008;108:254–260.
- De Nunzio C., Albisinni S., Freedland S.J., Miano L., Cindolo L., Finazzi Agro E. Abdominal obesity as risk factor for prostate cancer diagnosis and high grade disease: a prospective multicenter Italian cohort study. Urol Oncol. 2013;31:997–1002.
- Irani J., Lefebvre O., Murat F., Dahmani L., Dore B. Obesity in relation to prostate cancer risk: comparison with a population having benign prostatic hyperplasia. BJU Int. 2003;91:482–484.
- Park J., Cho S.Y., Lee S.B., Son H., Jeong H. Obesity is associated with higher risk of prostate cancer detection in a Korean biopsy population. BJU Int. 2014;114:891–895.
- Di Zazzo E, Galasso G, Giovannelli P, Di Donato M, Castoria G. Estrogens and their receptors in prostate cancer: therapeutic implications. Front Oncol. 2018;8:2.