Link between circadian rhythm and benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS)

Abstract

Background: Benign prostatic hyperplasia (BPH) is the most common urologic disease in aging males, affecting 50% of men over 50 and up to 80% of men over 80 years old. Its negative impact on health-related quality of life implores further investigation into its risk factors and strategies for effective management. Although the exact molecular mechanisms underlying pathophysiological onset of BPH are poorly defined, the current hypothesized contributors to BPH and lower urinary tract symptoms (LUTS) include aging, inflammation, metabolic syndrome, and hormonal changes. These processes are indirectly influenced by circadian rhythm disruption. In this article, we review the recent evidence on the potential association of light changes/circadian rhythm disruption and the onset of BPH and impact on treatment.

Methods: A narrative literature review was conducted using PubMed and Google Scholar to identify supporting evidence. The articles referenced ranged from 1975 to 2023.

Results: A clear relationship between BPH/LUTS and circadian rhythm disruption is yet to be established. However, common mediators influence both diseases, including proinflammatory states, metabolic syndrome, and hormonal regulation that can be asserted to circadian disruption. Some studies have identified a possible relationship between general LUTS and sleep disturbance, but little research has been done on the medical management of these diseases and how circadian rhythm disruption further affects treatment outcomes.

Conclusions: There is evidence to implicate a relationship between BPH/LUTS and circadian rhythm disruptions. However, there is scarce literature on potential specific link in medical management of the disease and treatment outcomes with circadian rhythm disruption. Further study is warranted to provide BPH patients with insights into circadian rhythm directed appropriate interventions.

Keywords: benign prostate growth; benign prostatic hyperplasia; circadian rhythm disruption; light; lower urinary tract symptoms; racial disparities; risk factors; therapeutic management.

Figure 1:

Schema summarizing the relationships between circadian rhythm/sleep disruption and prostatic diseases through shared mediators. There is an established correlation between cellular circadian rhythm disruption and prostate cancer, represented by the solid arrow. Relationships with between circadian rhythm disruption and prostatic disorders through shared mediators is represented by faded arrows. Circadian rhythm disruption leads to pro-inflammatory states, potentially influencing BPH. Circadian rhythm disruption is also indirectly associated (via metabolic syndrome) with BPH. Sleep disruption leads to decreased testosterone secretion, that ultimately impact LUTS. The relationship between circadian rhythm disruption and BPH treatment management strategies, including medication administration, have not yet been determined, and is represented by the dashed arrow.