TNF and Insulin resistance: [18]. The atherosclerotic condition can reduce blood supply to the prostate and has been identified as a risk factor for BPH development [24], [25]. Third, SA is involved in insulin resistance [26], [27], which is a well-established risk factor for BPH [28]–[30]. Fourth, SA and BPH are complex diseases with genetic and environmental factors involved in their development. Previous studies have indicated that TNF-α gene promoter polymorphism is associated with an increased risk of obstructive SA [31] and observed the association between TNF-α gene promoter polymorphism and risk of BPH [32].