Letter to the editor: Impact of metabolic syndrome on response to medical treatment of benign prostatic hyperplasia

We have read the article by Cyrus et al. [1], which was an interesting study investigating the impact of metabolic syndrome (MetS) on the treatment of benign prostatic hyperplasia (BPH). In their study, Cyrus et al. tried to evaluate the effect of MetS on the response to combination therapy with an α-blocker and 5α-reductase inhibitor (5ARI) after a 3-month period of therapy. Although the mean prostate volume of the patients with MetS was significantly higher than that that of the controls, significant differences in the International Prostate Symptom Score and its components were shown between patients with and without MetS. The authors suggested with this finding that MetS negatively affected the clinical response of BPH to medical treatment. Hyperinsulinemia in patients with BPH might have increased sympathetic nervous system activity, which contributes to an increase of prostate smooth muscle tone [2]. Selective α1-blockers reduce urethral closure resistance and inhibit smooth muscle tone in the prostate and are the firstline medical treatment option for men with BPH. 5ARIs block the conversion of testosterone to dihydrotestosterone and are approved for the treatment of BPH. The duration of treatment with finasteride in the study was 3 months. In the European Association of Urology Guidelines, which include benign prostatic obstruction, it Letter to the e ditor: Impact of metabolic syndrome on response to medical treatment of benign prostatic hyperplasia