C URRENT O PINION Associations of obesity, physical activity and diet with benign prostatic hyperplasia and lower urinary tract symptoms Omer A. Raheem a and J. Kellogg Parsons a,b,c Purpose of review Epidemiological and clinical data indicate that modifiable lifestyle factors – including obesity, physical activity, and diet – significantly influence the risks of symptomatic benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Recent findings Modifiable factors associated with significantly increased risks of symptomatic BPH and LUTS include obesity and consumption of meat and fat. Factors associated with decreased risks include increased physical activity, vegetable consumption, and moderate alcohol intake. Obesity potentially attenuates the clinical efficacy of 5a-reductase inhibitors (5-ARI). Randomized clinical trials of lifestyle alterations – such as weight loss, exercise, and diet – for the prevention or treatment of BPH and LUTS have yet to be performed. Summary Obesity, physical activity, and diet substantially alter the risks of symptomatic BPH and LUTS. 5-ARIs exhibit diminished efficacy in obese patients. Although clinical trials of lifestyle modifications have yet to be undertaken, it is reasonable to promote weight loss, exercise, and healthy diet within the context of standard treatments for symptomatic BPH and LUTS. Keywords benign prostatic hyperplasia, diet, lower urinary tract symptoms, obesity, physical activity INTRODUCTION Symptomatic benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are highly prevalent conditions among older men with sub- stantial adverse effects on the public health. In the USA, the estimated prevalence of BPH among men aged 60–69 years exceeds 70% [1]. By 2018, an estimated 612 million men will have BPH globally [2]. Estimated annual costs of LUTS treatment in the USA alone totals upwards of $3.9 billion dollars [1,3]. Despite widespread medication use, the inci- dence of acute urinary retention secondary to BPH has significantly increased in a large, ethnically diverse population of US men [4 & ]; in addition, hospitalizations for BPH secondary to acute renal failure in the USA have increased over the last decade [5 && ]. LUTS have been associated with an increased risk of falls, reduced quality of life, depres- sion, and increased mortality [6–9]. A relatively recent development in the under- standing of BPH and LUTS is the observation that modifiable lifestyle factors – including adiposity, physical activity, and diet – influence the natural history of these conditions. Accumulating data suggest that many of the same metabolic disturb- ances and lifestyle factors associated with cardio- vascular disease also alter the risks of BPH and LUTS. These observations are important because they suggest targets for prevention and treatment. Herein, we review associations of adiposity, exercise, and diet life with BPH and LUTS. a Department of Urology, UC San Diego Health System, San Diego, b Division of Urologic Oncology, UC San Diego Moores Cancer Center, La Jolla and c Section of Surgery, VA San Diego Healthcare System, San Diego, California, USA Correspondence to J. Kellogg Parsons, MD, MHS, FACS, Division of Urologic Oncology, UC San Diego Moores Cancer Center, 3855 Health Sciences Drive #0987, La Jolla, CA 92093-0987, USA. Tel: +1 858 822 6187; fax: +1 858 822 6188; e-mail: jkparsons@ucsd.edu Curr Opin Urol 2014, 24:10–14 DOI:10.1097/MOU.0000000000000004 www.co-urology.com Volume 24  Number 1  January 2014 REVIEW