Challenging the Inevitability of Prostate Enlargement: Low Levels of Benign Prostatic Hyperplasia Among Tsimane Forager-Horticulturalists.
BACKGROUND
Often considered an inevitable part of male aging, benign prostatic hyperplasia (BPH) is the most common non-life threatening disease to affect men in Western populations. We examine age-related change in prostate size and BPH risk and related serum biomarkers among the Tsimane Amerindians of the Bolivian Amazon who live a traditional lifestyle of hunting and small-scale horticulture. The Tsimane are a critical case study for understanding the etiology of BPH as they have low levels of obesity and metabolic syndrome, as well as lower levels of testosterone than age matched U.S. males, factors associated with BPH in previous research.


METHODS
Ultrasounds were conducted on 348 men aged 28-89 years (median age 56 years). Testosterone, prostate specific antigen, sex hormone binding globulin, and glycosylated hemoglobin were examined in relationship to prostate size and BPH.


RESULTS
Tsimane have less than half of the BPH prevalence experienced by U.S. men, and prostate volumes 62.6% smaller. While Tsimane have low levels of testosterone and subclinical levels of metabolic syndrome compared to U.S. men, Tsimane with high testosterone were more likely to experience BPH, as were those with higher glycosylated hemoglobin, suggesting targets for clinical interventions to reduce BPH.


CONCLUSIONS
These results have clinical significance for the growing number of men taking testosterone supplementation; even at low levels the additional testosterone exposure could be placing these men at higher risk of BPH. Overall, these data suggest that BPH may not have been an inevitable part of male aging throughout human evolutionary history.
Department of Anthropology, University of California Santa Barbara. trumble@ucsb.edu.
Benjamin C
BC
Trumble
Department of Anthropology, University of New Mexico, Albuquerque. Institute for Advanced Study in Toulouse, France.
Jonathan
J
Stieglitz
Tsimane Health and Life History Project, San Borja, Bolivia.
Daniel
D
Eid Rodriguez
Tsimane Health and Life History Project, San Borja, Bolivia.
Edhitt
E
Cortez Linares
Department of Anthropology, University of New Mexico, Albuquerque.
Hillard S
HS
Kaplan
Department of Anthropology, University of California Santa Barbara.
Michael D
MD
Gurven
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001838:Bolivia / Q000453:epidemiology; D000067565:Farmers; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D014463:Ultrasonography
D015415:Biomarkers; D006442:Glycated Hemoglobin; D017430:Prostate-Specific Antigen; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone
Benign prostatic hyperplasia; Evolutionary medicine; Metabolic syndrome; Prostate specific antigen; Testosterone