Diabetes Mellitus and the Prostate: The Odd Pairing

The prostate is a susceptible organ that could be impacted by metabolic diseases such as diabetes mellitus (DM), and more specifically type 2 DM (T2DM). Different literature sources suggest various associations between T2DM and prostatic diseases, most notably prostate cancer (PCa) and benign prostatic hyperplasia (BPH). This article serves as a comprehensive literature review on T2DM and anti-DM agents concerning PCa and BPH. Despite DM playing a role in contributing to the high risk of different malignancies and leading to worse mortality outcomes, multiple sources from the literature explain that DM might hold a protective effect against PCa. Several reasons could be discussed concerning such a lower risk, such as the dominant phenotype of T2DM patients, genomics, and T2DM's impact on testosterone and prostatic vasculature. It also appears that the risk is associated with the time of T2DM diagnosis. Still, such a notion is not universally established, as some studies show that pre-existing DM in patients diagnosed with PCa increases mortality risk. DM might produce obstructive and irritative symptoms that mimic those of BPH. Such symptoms could be more challenging to respond to typical BPH therapy if glycemic control was not optimal. The dominant literature sources suggest that T2DM, obesity, and metabolic syndrome increase the risk of BPH. Metformin appears to be the most prominent anti-DM agent in terms of its positive effect on inhibiting PCa cell growth. Multiple trials are still ongoing to discover more of its anti-malignant roles. Conflicting reports are still present regarding multiple anti-DM agents and their true impact on PCa and BPH. It is vital to recognize that a relationship exists between prostatic diseases and T2DM. Close follow-up and screening are needed from both ends of the clinical evaluation.