The Association Between Metabolic Syndrome and Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis

The aim of this study is to systematically evaluate the association between metabolic syndrome (MetS) and key clinical parameters of benign prostatic hyperplasia (BPH), including International Prostate Symptom Score (IPSS), prostate volume (PV), and the prevalence of MetS among men with BPH. A systematic search of PubMed, Embase, Web of Science, Scopus, and the Cochrane Library was conducted from inception to March 31, 2025, with the search implementation completed on April 5, 2025 for all databases. Observational studies comparing BPH patients with and without MetS were included. Random-effects models were used to pool standardized mean differences (SMDs), mean differences (MDs), and prevalence estimates. Heterogeneity, publication bias, subgroup analyses, sensitivity analyses, and meta-regression were performed according to prespecified criteria. Ten studies involving 3,947 BPH patients met the inclusion criteria. Pooled analyses demonstrated that MetS was associated with larger prostate volume (PV) and a tendency toward higher IPSS, although the latter showed substantial variability across studies. The prevalence of MetS among BPH patients was high, with considerable geographic and temporal variation. Subgroup analyses indicated that sample size influenced effect estimates, and meta-regression identified age, sample size, and publication year as contributors to heterogeneity. MetS is closely associated with prostate enlargement and symptom burden in men with BPH. These findings highlight the metabolic-urological interplay and support the integration of metabolic assessment into BPH management strategies. Large-scale prospective studies are needed to clarify causality and evaluate whether metabolic interventions can alter BPH progression.