2018 Congress of the Mexican Association of Oncological Urology

Metabolic Syndrome and Prostate Cancer

Acapulco, GRO. Mexico (UroToday.com) Nowadays there are multiple articles discussing the relationship between prostate cancer and metabolic syndrome. This association was first seen in 2004, now we know there is an inverse and positive relation between metabolic syndrome and prostate cancer. Patients with metabolic syndrome are more susceptible to aggressive and high-risk prostate cancer.

The mechanisms proposed are: 
  • High levels of IGF-1 (interfere with cellular proliferation and reduce apoptosis)
  • DNA alterations that increase free radicals
  • Altered levels of sexual steroids. (<SHBG, testosterone/estradiol relation inverted, > estradiol. 
  • Chronic inflammation with increased levels of cytokines (IL-6, TNF, NFkB, PCR)
In the REDUCE study, high-risk prostate cancer was related in patients with >3 components of metabolic syndrome, although it was not statistically significant.  

 In 2013, a 15 article metanalysis showed that there is not a clear risk association with prostate cancer diagnosis but there is a clear risk with advanced and high-risk prostate cancer, rate of recurrence after radical prostatectomy and adverse histopathology.  However, the cancer-specific mortality was not altered. 

In 2017, a 24 article metanalysis tried to establish metabolic syndrome as a marker in new nomograms. However,  the limitations of the studies to determine the syndrome as a clear factor were: 

  • Socioeconomic differences and screening in different regions of the world. 
  • Not all the definitions around the world are the same for obesity and hypertension.  
  • The follow up of different components of the syndrome.
  • Metabolic syndrome frequently analyzed as a binary variable. 
Three studies in progress (MEAL study: The men´s eating and living, MAST: Metformin Active Surveillance Trial and LIGAND: Lipitor and biGuanide to Androgen Delay) may clarify the relationship between metabolic syndrome and prostate cancer. 

Dr. Castillejos concludes that there is no relation between the syndrome and the risk of prostate cancer diagnosis. However, patients already diagnosed with prostate cancer with metabolic syndrome may be at risk of advanced and high-risk prostate cancer. At least one component of the syndrome or the whole syndrome increased the progression of prostate cancer. It is still to be clarified. 

The metabolic syndrome could be included in new screening and prognostic nomograms or may change our decision to biopsy a patient in the future. 

Presented by: Castillejos M. Ricardo. MD at Instituto Nacional Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico. 

Written by: Carlos Jimenez Ornelas, MD. Resident of Urology. Instituto Nacional Ciencias Medicas y Nutricion Salvador Zubiran @dr.jimorn along with Ashish M. Kamat, MD, at the 2018 Congreso de la Asociacion Mexicana de Urologia Oncologica – July 25-28, 2018, Acapulco, Guerrero. 
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