This prospective cohort study investigated the association between dyslipidemia and prostate volume progression in middle-aged Chinese men. A total of 5607 men aged >40 years at The Second Xiangya Hospital of Central South University (Changsha, China), between January 2020 and January 2023, who did not have baseline benign prostatic hyperplasia, were followed for three years. Participants were categorized by their baseline lipid status according to Chinese guidelines. Prostate volume was measured annually, using transrectal ultrasound, with enlargement defined as a volume of ≥31 ml. The results showed that 48.0% of men with dyslipidemia developed prostatic enlargement, compared to 36.5% with normal lipid levels. Elevated ratios of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol and total cholesterol to high-density lipoprotein cholesterol were significantly associated with an increased risk in a dose–response manner. This association was independent of age, body mass index, and fasting glucose levels. High-density lipoprotein cholesterol demonstrated a protective effect. These findings suggest that dyslipidemia, particularly as reflected in specific lipid ratios, is an independent and modifiable risk factor for accelerated prostatic enlargement. This indicates that lipid assessment could be valuable for early risk stratification and prevention.

Keywords: cohort studies; dyslipidemias; lipids; prostatic hyperplasia; prostate volume; risk factors