Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men

We defined risk factors for a clinical diagnosis of benign prostatic hyperp lasia (BPH) among subjects of the population-based Massachusetts Male Aging Study. In 1987-89 1709 men aged 40-70 provided baseline risk factor data a nd were followed for a mean of 9 years; 1019 men without prostate cancer pr ovided follow-up data. We classified men with clinical BPH at follow-up if they reported (1) frequent or difficulty urinating and were told by a healt h professional that they had an enlarged or swollen prostate or (2) if they reported having surgery for BPH. At follow-up the prevalence of clinical B PH was 19.4%, increasing from 8.4% of men aged 38-49 years to 33.5% of men aged 60-70 years (P < 0.001 for trend). Elevated free PSA levels (age- and total PSA-adjusted OR, top vs. bottom quartile ng/mL 4.4, 95% Cl 1.9-10.5). heart disease (age-adjusted OR 2.1, CI 1.3-3.3), and use of beta-blocker m edications (OR 1.8, CI 1.1-3.0) increased odds for BPH, while current cigar ette smoking (OR 0.5, CI 0.3-0.8) and high levels of physical activity (top vs. bottom quartile kcals/day OR 0.5, CI 0.3-0.9) decreased odds of BPH. A ll but the medication effects persisted in fully adjusted multivariable mod els. Total or fat calorie intake, sexual activity level, alcohol intake, bo dy mass index, waist-hip ratio, diastolic blood pressure, a history of diab etes, hypertension, vasectomy, or serum levels of androgens or estrogens di d not individually predict clinical BPH. We conclude that physical exercise and cigarette smoking appear to protect against development of clinical BP H. Elevated free PSA levels predict clinical BPH independent of total PSA l evels. Risk associated with heart disease does not appear to be due solely to detection bias or to effects of heart disease medications. A wide variet y of other characteristics appear to have no influence on risk for clinical BPH. (C) 2001 Elsevier Science Inc. All rights reserved.