Dissecting the Association Between Metabolic Syndrome and Prostate Cancer Risk: Analysis of a Large Clinical Cohort (original) (raw)
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The Metabolic Syndrome is Associated with More Aggressive Prostate Cancer
Asian Pacific Journal of Cancer Prevention, 2014
The aim of this study was to analyze any association between the metabolic syndrome (MetS) and risk of prostate cancer (PCa) and cancer grade among men undergoing radical prostatectomy for PCa. Materials and Methods: 50 patients with MetS and 50 patients without MetS who undervent radical prostatectomy (RP) were included in the study. Age at biopsy, height, weight, digital rectal examination (DRE), pre-biopsy PSA levels, prostate volume, histopathologic diagnosis after surgery and gleason scores were collected data from all patients. Histologic material obtained at biopsy was given a Gleason score; tumours with a Gleason score ≥7 were considered high grade and <7 were considered low grade. Results: The mean age at the time of biopsy was 63.7±5.94 in patients with MetS and 61.6±6.14 in patients without MetS. Men with MetS had significantly lower PSA levels (p=0.01) (7.21±2.74 and 8.81±2.72, respectively). Also, the men with MetS had higher RP tumor grade (p=0.04). Conclusions: Men with MetS undergoing RP have lower PSA levels and have significantly higher grade PCa. We must be careful for screening PCa in patients with MetS. Although the patients had lower PSA levels, they may have high grade disease.
BMC Public Health, 2015
Background: The role of metabolic syndrome (MetS) in prostate cancer risk is still debated. We investigated it in a large population-based case-control study. Methods: Cases were 1937 men with incident prostate cancer, aged ≤75 years, diagnosed across French hospitals in the Montreal area between 2005 and 2009. Concurrently, 1995 population controls from the same residential area and age distribution were randomly selected from electoral list of French-speaking men. Detailed lifestyle and medical histories, and anthropometric measures, were collected during in-person interviews. Prevalence of MetS components (type 2 diabetes, high blood pressure, dyslipidemia and abdominal obesity) was estimated at 2 years before diagnosis for cases/ interview for controls, and at ages 20, 40, 50 and 60. Logistic regression was used to estimate odds ratios (OR) and 95 % confidence intervals for the association between MetS and prostate cancer risk. Results: A history of MetS (≥3 components vs <3) was associated with a reduced risk of prostate cancer (OR = 0.70 [0.60, 0.82]) after considering potential confounders. The negative association was particularly pronounced with a young age (≤40 years) at MetS onset (OR = 0.38 [0.16-0.89]), did not vary according to prostate cancer aggressiveness, and was only partly explained by the presence of type 2 diabetes. A risk decrease was observed with the number of MetS components, suggesting a synergistic interaction of the components. Discussion: The observed negative association, consistent with results from other North American populations undergoing regular prostate cancer screening, underlines the importance of considering PSA-testing when studying the MetS-prostate cancer association. Conclusions: Findings from this study are consistent with an inverse association between MetS and prostate cancer risk.
A stage-dependent link between metabolic syndrome components and incident prostate cancer
Nature Reviews Urology, 2018
Metabolic syndrome-a common condition in countries with Western lifestyles-comprises a number of disorders, including diabetes, obesity, hypertension, and insulin resistance, which are all risk factors for cardiovascular disease. Evidence from epidemiological investigations and experimental, translational, and clinical studies supports the emerging hypothesis that metabolic syndrome might also be an important aetiological factor in the progression of cancers at almost all sites and might be associated with increased overall cancer mortality 1,2. In recent decades, evidence has accumulated to indicate that metabolic syndrome might also be associated with the progression of prostate cancer 3 , and several studies have An association between components of metabolic syndrome and incident prostate cancer might have been seen more frequently in the pre-PSA era, when diagnosis was more driven by symptoms and, therefore, more men were diagnosed with high-stage prostate cancer 7,8. The PSA-driven diagnostic approach used today results in a different case mix, with an increased proportion of low-stage (T1c and T1-T2) prostate cancer being diagnosed 7,8. This shift in proportions of high-stage versus low-stage prostate cancer in study populations will likely have influenced the observed link between metabolic syndrome and incident prostate cancer. We hypothesize that in studies in which the proportion of patients with T1c prostate cancer is greater than the proportion of patients with T2-T4 prostate cancer, and those in which the proportion of patients with T1-T2 prostate cancer is greater than the proportion with T3-T4 prostate cancer (all diagnosed on the basis of PSA level), the link between metabolic syndrome and its components and incident prostate cancer is concealed by study-related bias mechanisms. Such a finding would result in an inverse association between metabolic syndrome and its components and incident prostate cancer. If this hypothesis is true, then as the proportions of T1c and T1-T2 prostate cancer diagnoses increase as a result of PSA testing, any positive associations between metabolic syndrome and its components and prostate cancer should disappear or become negative. In this Perspectives article, we test this hypothesis using available evidence from studies with reported stage characteristics to investigate the relationship between metabolic syndrome and its components and prostate cancer at different proportions of T1c and T1-T2 disease.
American Journal of Epidemiology, 2006
The aim of the study was to establish whether metabolic syndrome predicts the incidence of prostate cancer. The hypothesis was tested using the 27-year follow-up of the prospective cohort of 16,209 men aged 40-49 years who participated in the Oslo Study in 1972-1973. Men with established diabetes and men with cancer diagnosed before screening were excluded, leaving 15,933 for analyses. Metabolic syndrome is here composed of body mass index, nonfasting glucose, triglycerides, and blood pressure or drug-treated hypertension. Two analytical approaches were compared, namely, predefined (adjusted from National Cholesterol Education Program) and quartile values of risk factors. Age, body mass index, and sedentary versus intermediate physical activity at work were significant predictors in univariate proportional hazards regression analyses. Combinations of any two (relative risk ¼ 1.23; p ¼ 0.04) or any three (relative risk ¼ 1.56; p ¼ 0.00) factors of the metabolic syndrome using quartile values of risk factors were predictive of prostate cancer. The number of cases for four factors was too small for analyses. Predefined values of the risk factors were not found to be predictive. In conclusion, metabolic syndrome was found to predict prostate cancer during 27 years of follow-up, indicating an association between insulin resistance and the incidence of prostate cancer. incidence; insulin resistance; metabolic syndrome X; prospective studies; prostatic neoplasms Abbreviations: CI, confidence interval; IGF-1, insulin-like growth factor-1; IGFBP, insulin-like growth factor binding protein; NCEP, National Cholesterol Education Program; RR, relative risk.
Cancer Epidemiology Biomarkers & Prevention, 2010
Background-Associations between Metabolic Syndrome (MetS) components and prostate cancer development have not been studied comprehensively; results have been divergent. Using the National Cholesterol Education Program Adult Treatment panel III (NCEP) and International Diabetes Federation (IDF) definitions of the MetS we investigated such associations taking competing risks of death into consideration.
Archivio Italiano di Urologia e Andrologia
Introduction and objective: Even though the only established risk factors for prostate cancer (PCa) are age, ethnic origin and family history, there are data suggesting that environmental factors, such as the presence of metabolic syndrome (MetS), may also play a role in the etiology of the disease. The aim of this study is to correlate MetS with PCa diagnosis and Gleason score (GS) in patients undergoing transrectal ultrasound guided prostate biopsy.Materials and methods: This is a prospective, single-center study including 378 patients who underwent transrectal ultrasound guided prostate biopsy in our department during the years from 2018 to 2019. Patients were divided into two groups according to the presence of PCa. Group A included 197 patients diagnosed with PCa while Group B consisted of 181 patients without PCa in their biopsy result. Multiple variables such as the presence of MetS and its components were evaluated in correlation to the presence of PCa and PCa characteristic...
Prospective study on metabolic factors and risk of prostate cancer
Cancer, 2012
BACKGROUND: There are inconsistent data regarding the association between metabolic factors, separately and combined, and the risk of prostate cancer and death from prostate cancer. METHODS: In the Metabolic Syndrome and Cancer Project (Me-Can), data on body mass index (BMI); blood pressure; and blood levels of glucose, cholesterol, and triglycerides were collected for 289,866 men. Cox proportional hazard models were used to calculate relative risks (RRs) by exposures in quintiles as well as for z scores (with a mean of 0 and a standard deviation of 1) together with a composite sum of scores to assess the combined effect of metabolic factors. RRs were corrected for random errors in measurement. RESULTS: During a mean follow-up of 12 years, 6673 men were diagnosed with prostate cancer and 961 died of the disease. Men with high levels of glucose and triglycerides were found to have a decreased risk of prostate cancer: top versus bottom quintile of glucose: RR, 0.82 (95% confidence interval [95% CI], 0.62-1.08; P value for trend ¼ .03) and top versus bottom quintile of triglycerides: RR, 0.88 (95% CI, 0.74-1.04; P value for trend ¼ .001). High BMI, elevated blood pressure, and a high composite z score were found to be associated with an increased risk of death from prostate cancer: top versus bottom quintile of BMI: RR, 1.36 (95% CI, 1.08-1.71); systolic blood pressure: RR, 1.62 (95% CI, 1.07-2.45); and per 1unit increase of the composite z score: RR, 1.13 (95% CI, 1.03-1.25). CONCLUSIONS: The authors found no evidence of an association between high levels of metabolic factors and the risk of prostate cancer, but high BMI, elevated blood pressure, and a composite score of all metabolic factors were associated with an increased risk of death from prostate cancer. Cancer 2012;118:6199-206. V C 2012 American Cancer Society.
BJU International, 2014
To evaluate the relationship between number of metabolic syndrome (MetS)-like components and prostate cancer diagnosis in a group of men where nearly all biopsies were taken independent of prostate-specific antigen (PSA) level, thus minimising any confounding from how the various MetS-like components may influence PSA levels. Subjects/Patients and Methods We analysed data from 6426 men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study with at least one on-study biopsy. REDUCE compared dutasteride vs placebo on prostate cancer risk among men with an elevated PSA level and negative pre-study biopsy and included two on-study biopsies regardless of PSA level at 2 and 4 years. Available data for MetS-like components included data on diabetes, hypertension, hypercholesterolaemia, and body mass index. The association between number of these MetS-like components and prostate cancer risk and low-grade (Gleason sum <7) or high-grade (Gleason sum >7) vs no prostate cancer was evaluated using logistic regression. Results In all, 2171 men (34%) had one MetS-like component, 724 (11%) had two, and 163 (3%) had three or four. Men with more MetS-like components had lower PSA levels (P = 0.029). One vs no MetS-like components was protective for overall prostate cancer (P = 0.041) and low-grade prostate cancer (P = 0.010). Two (P = 0.69) or three to four (P = 0.15) MetS-like components were not significantly related to prostate cancer. While one MetS-like component was unrelated to high-grade prostate cancer (P = 0.97), two (P = 0.059) or three to four MetS-like components (P = 0.02) were associated with increased high-grade prostate cancer risk, although only the latter was significant. Conclusion When biopsies are largely PSA level independent, men with an initial elevated PSA level and a previous negative biopsy, and multiple MetS-like components were at an increased risk of high-grade prostate cancer, suggesting the link between MetS-like components and high-grade prostate cancer is unrelated to a lowered PSA level.
Features of the metabolic syndrome and prostate cancer in African-American men
Cancer, 2007
BACKGROUND. Metabolic syndrome refers to a cluster of conditions that includes hypertension, dyslipidemia, central adiposity, and high blood glucose levels. Over the past decade, a growing body of literature suggests that metabolic syndrome may be associated with several different forms of cancer. Because prostate cancer risk is highest among African Americans, and these men, similarly, are more prone to developing specific features of the metabolic syndrome, including hypertension and type-2 diabetes, any relationships would have a significant impact on developing strategies for the primary prevention of prostate cancer.