This retrospective study took place between May 2010 and October 2018. All patients had undergone repeat biopsy (12-core) for persistent clinically suspicious PC, due: PSA>=4 ng/ml, or suspicious digital rectal examination, or more than three biopsy cores with High-Grade Prostatic Intraepithelial Neoplasia (HGPIN), and 6-month after a first biopsy. A PSA>20 ng/ml was the main exclusion criteria. A 12-14 core prostate biopsy template was used in all biopsies. Metabolic syndrome was defined according to the Adult Treatment Panel III criteria. The authors utilized a binary logistic model to assess risk factors of PC on repeat prostate biopsy.
A total of 309 patients with a median age of 68 (62-73). The key characteristics of the patients are shown in table 1. A total of 109 patients had a diagnosis of metabolic syndrome. Table 2 demonstrates the comparison between patients with and without metabolic syndrome, and table 3 stratifies the patients according to whether they had PC or not.
Table 1 – Patient characteristics:
Table 2 – Stratification of the patients according to whether or not they had metabolic syndrome:
Table 3 – Stratification of patients by prostate cancer:
Patients with metabolic syndrome were shown to have a higher rate of PC, and PC patients were also shown to have a higher rate of metabolic syndrome. On multivariable regression analysis it was shown that age (OR 1.1, 95% CI 1.03-1.18, P=0.04), metabolic syndrome (OR 3.27, 95% CI 1.28-8.3, p=0.013) and HGPIN (OR=6.13, 95% CI 2.47-15.25, p<0.0001) were associated with an increased risk of the diagnosis of Gleason score>=7 PC.
The authors concluded that metabolic syndrome was shown to be an independent predictor of PC and particularly of high-grade PC. The authors propose validation of these results prospectively in a large multicenter cohort, before attempting to reduce the number of unnecessary biopsies in patients with a previous negative biopsy.
Presentred by: Cosimo De Nunzio, Department of Urology, Ospedale Sant Andrea, Sapienza University, Rome, Italy
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois