Influence of Metabolic Syndrome on Prostate Cancer Stage, Grade and Overall Recurrence Risk in Men Undergoing Radical Prostatectomy.

OBJECTIVE - Metabolic syndrome (MetS) is associated with an increased risk of finding prostate cancer (PC) overall and high grade disease on biopsy. This study sought to determine if MetS is associated with adverse final pathology and risk of overall recurrence in men undergoing radical prostatectomy (RP).

METHODS - Men undergoing RP (2004-2013) were identified using our prospectively-maintained institutional database. MetS was defined by ≥3 of 5 components (obesity, dysglycemia, hypertension, low HDL-cholesterol, and high triglycerides). Multivariable logistic regression models were created for PC grade and stage on final pathology. Kaplan-Meier and multivariable Cox regression analyses were performed to model overall recurrence, defined by biochemical recurrence (post-operative serum PSA ≥0.2ng/mL) or use of salvage therapies.

RESULTS - Of 1939 men, 439 (22.6%) had MetS. MetS (≥3 vs. 0 components) was associated with an increased odds of Gleason 8-10 disease (OR=2.49, 95%CI=1.32-4.67, p=0.005) and extraprostatic disease (OR=1.35, 95%CI=1.02-1.80, p=0.04). Decreased use of nerve-sparing in men with MetS was noted. In unadjusted analyses, MetS was associated with a significantly increased risk of receiving salvage therapy (HR=1.38, 95%CI=1.04-1.83, p=0.03) and a near-significant increased overall recurrence risk (HR=1.20, 95%CI=0.94-1.53, p=0.15). These associations were attenuated upon adjusting for disease-specific parameters (salvage therapy: HR=1.03, 95%CI=0.76-1.40, p=0.87; overall recurrence: HR=0.94, 95%CI=0.72-1.21, p=0.62).

CONCLUSIONS - MetS is associated with an increased odds of extraprostatic and high-grade disease on final RP pathology, which appears to drive an increased risk of needing salvage therapy after RP. However, with more aggressive resection, differences in failure-free outcomes were attenuated, suggesting that men with MetS should not be precluded from RP.

Urology. 2016 Mar 22 [Epub ahead of print]

Bimal Bhindi, Wen Y Xie, Girish S Kulkarni, Robert J Hamilton, Michael Nesbitt, Antonio Finelli, Alexandre R Zlotta, Andrew Evans, Theodorus H van der Kwast, Shabbir M H Alibhai, John Trachtenberg, Neil E Fleshner

Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Urology, Dept. of Surgery, University of Western Ontario, London, Ontario, Canada. Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.; Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada. Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Dept. of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada. Dept. of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada. Dept. of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.