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

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

doi:10.1016/j.urology.2016.01.041

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

Urology. 2016 Jul:93:77-85. doi: 10.1016/j.urology.2016.01.041. Epub 2016 Mar 22.

Authors

Affiliations

¹ Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: [email protected].
² Division of Urology, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
³ Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.

PMID: 27015944
DOI: 10.1016/j.urology.2016.01.041

Abstract

Objective: Metabolic syndrome (MetS) is associated with an increased risk of finding prostate cancer 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 high-density lipoprotein-cholesterol, and high triglycerides). Multivariable logistic regression models were created for prostate cancer grade and stage on final pathology. Kaplan-Meier and multivariable Cox regression analyses were performed to model overall recurrence, defined by biochemical recurrence (postoperative serum prostate-specific antigen ≥0.2 ng/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 (odds ratio [OR] = 2.49, 95% confidence interval [CI] = 1.32-4.67, P = .005) and extraprostatic disease (OR = 1.35, 95% CI = 1.02-1.80, P = .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 (hazard ratio [HR] = 1.38, 95% CI = 1.04-1.83, P = .03) and a near-significant increased overall recurrence risk (HR = 1.20, 95% CI = 0.94-1.53, P = .15). These associations were attenuated upon adjusting for disease-specific parameters (salvage therapy: HR = 1.03, 95% CI = 0.76-1.40, P = .87; overall recurrence: HR = 0.94, 95% CI = 0.72-1.21, P = .62).

Conclusion: 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.

MeSH terms

Humans
Male
Metabolic Syndrome / complications*
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local / epidemiology*
Neoplasm Staging
Prostatectomy* / methods
Prostatic Neoplasms / complications*
Prostatic Neoplasms / pathology
Prostatic Neoplasms / surgery*
Risk Assessment