Antidiabetic drugs, glycemic control and risk of benign prostatic hyperplasia

• Published in: The Prostate Vol. 83; no. 3; pp. 246 - 258
• Main Authors: Nygård, Lotta H., Talala, Kirsi, Taari, Kimmo, Tammela, Teuvo L. J., Auvinen, Anssi, Murtola, Teemu J.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2023
• Subjects: antidiabetic drugs; Antidiabetics; Antihypertensives; benign prostatic hyperplasia; Blood Glucose; cohort; Diabetes; Diabetes Mellitus; Diagnosis; Drug abuse; Drug use; Genital diseases; Glucose; Glycemic Control; Humans; Hyperglycemia; Hyperplasia; Hypoglycemic Agents - adverse effects; Inflammation; Insulin; Insulin - adverse effects; Male; Prostate cancer; Prostatic Hyperplasia - drug therapy; Prostatic Hyperplasia - epidemiology; Prostatic Hyperplasia - surgery; Prostatic Neoplasms; risk; Risk Factors; Statins; Surgery; blood glucose; cohort; risk; antidiabetic drugs; benign prostatic hyperplasia
• ISSN: 0270-4137; 1097-0045; 1097-0045
• DOI: 10.1002/pros.24456

Background Diabetes has been associated with an increased risk of benign prostatic hyperplasia (BPH). However, the role of antidiabetic drugs as a BPH risk factor is unclear. The objective of our study was to examine the risk of BPH by antidiabetic drug use and glycemic control in a large population‐based cohort of Finnish men. Methods A total of 74,754 men in the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC) free of BPH at baseline in 1996–1999 were linked to the national medication reimbursement database for information on physician‐prescribed antidiabetic drug purchases. Information on recorded BPH procedures and diagnoses was obtained from the National Care Register for Health Care, and for a subgroup of 17,739 men, information on blood glucose levels (BGLs) from the Fimlab Laboratories database. Cox regression with antidiabetic drug use and BGL as time‐dependent variables was used to analyze the risks for starting BPH medication, recorded BPH diagnosis, and undergoing BPH surgery. The analysis was adjusted for age, use of statins, antihypertensive medication, and nonsteroidal anti‐inflammatory drugs. Results Of the subjects, 14,012 men (18.7%) used antidiabetic medication. Of the subgroup with fasting blood glucose data available, 7487 (42.2%) had diabetic level. The risks for BPH diagnosis (HR: 1.08, 95% CI: 1.03–1.13) and surgery (HR: 1.16, 95% CI: 1.09–1.24) were slightly elevated among antidiabetic drug users compared to nonusers. The association was strongest for insulin use. Similarly, risk of BPH surgery was increased in men with diabetic blood glucose compared to normoglycemic men. The risk association was attenuated by use of antidiabetic drugs. Conclusions Diabetic BGL and antidiabetic medication use, especially insulin, are associated with an elevated risk of BPH surgery compared to nondiabetic men. These findings support the roles of insulin use and untreated hyperglycemia as possible BPH risk factors.