Journal List > Korean J Urol > v.48(6) > 1004934

Han, Choi, Yu, Han, Chang, Jeong, Hong, Byun, and Lee: The Characteristics of Prostate Cancer with Metabolic Syndrome in Korean Men

Abstract

Purpose

Metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight, abdominal fat distribution, dyslipidemia, and hypertension, has been reported to have some association with prostate cancer. Here, we assessed the relationship between metabolic syndrome and prostate cancer.

Materials and Methods

We assessed a total of 261 men who underwent radical retropubic prostatectomy between January 2004 and May 2005. The patients were stratified into two groups, with metabolic syndrome (n=75) or without (n=186). Metabolic syndrome was defined by the criteria of National Cholesterol Education Program Adult Treatment Panel III. We compared the clinical and pathologic features of specimens between the groups.

Results

There was no significant difference between the two groups in terms of mean age, serum prostate specific antigen level, prostate size, Gleason score, and pathologic stage. The tumor volume of prostate cancer was significantly higher in the metabolic syndrome group (6.6±5.5cc vs 5.0±4.5cc, p=0.010). No significant differences were observed in extracapsular extension, seminal vesicle invasion, bladder neck invasion, angiolymphatic invasion, perineural invasion, and multicentricity of cancer between the two groups. As the component of metabolic syndrome increased, the tumor volume was also found to increase (p-value=0.025).

Conclusions

The data from our study support that metabolic syndrome is closely associated with the development and progression of prostate cancer.

References

1. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. Adults. N Engl J Med. 2003; 348:1625–38.
crossref
2. Kaaks R, Lukanova A, Kurzer MS. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev. 2002; 11:1531–43.
3. Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM. Fasting serum glucose level and cancer risk in Korean men and women. JAMA. 2005; 293:194–202.
crossref
4. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988; 37:1595–607.
crossref
5. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15:539–53.
crossref
6. Chung HW, Kim DJ, Jin HD, Choi SH, Ahn CW, Cha BS, et al. Prevalence of metabolic syndrome according to the new criteria for obesity. J Korean Diabetes Assoc. 2002; 5:431–42.
7. Kwon HS, Lee HJ, Lee JH, Choi YH, Ko SH. The prevalence and clinical characteristics of the metabolic syndrome in middle-aged Korean adults. Korean J Med. 2005; 68:359–68.
8. Renehan AG, Howell A. Preventing cancer, cardiovascular disease, and diabetes. Lancet. 2005; 365:1449–51.
crossref
9. Laukkanen JA, Laaksonen DE, Niskanen L, Pukkala E, Hakkarainen A, Salonen JT. Metabolic syndrome and the risk of prostate cancer in Finnish men: a population-based study. Cancer Epidemiol Biomarkers Prev. 2004; 13:1646–50.
10. Barnard RJ, Aronson WJ, Tymchuk CN, Ngo TH. Prostate cancer: another aspect of the insulin-resistance syndrome? Obes Rev. 2002; 3:303–8.
crossref
11. Freedland SJ, Terris MK, Platz EA, Presti JC Jr. Body mass index as a predictor of prostate cancer: development versus detection on biopsy. Urology. 2005; 66:108–13.
crossref
12. Hammarsten J, Hogstedt B. Clinical, haemodynamic, anthropometric, metabolic and insulin profile of men with high-stage and high-grade clinical prostate cancer. Blood Press. 2004; 13:47–55.
crossref
13. Wuermli L, Joerger M, Henz S, Schmid HP, Riesen WF, Thomas G, et al. Hypertriglyceridemia as a possible risk factor for prostate cancer. Prostate Cancer Prostatic Dis. 2005; 8:316–20.
crossref
14. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Executive summary of the third report of the national cholesterol education Program (NCEP). JAMA. 2001; 285:2486–97.
15. Western Pacific Regional Office of the World Health Organization, the International Obesity Task Force. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia;2000. http://www.obesity-asiapacific.com.
16. Valko M, Izakovic M, Mazur M, Rhodes CJ, Telser J. Role of oxygen radicals in DNA damage and cancer incidence. Mol Cell Biochem. 2004; 266:37–56.
crossref
17. Renehan AG, Zwahlen M, Minder C, O'Dwyer ST, Shalet SM, Egger M. Insulin-like growth factor (IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis. Lancet. 2004; 363:1346–53.
crossref
18. Hammarsten J, Hogstedt B. Hyperinsulinaemia: a prospective risk factor for lethal clinical prostate cancer. Eur J Cancer. 2005; 41:2887–95.
crossref
19. Porter MP, Stanford JL. Obesity and the risk of prostate cancer. Prostate. 2005; 62:316–21.
crossref
20. Baillargeon J, Pollock BH, Kristal AR, Bradshaw P, Hernandez J, Basler J, et al. The association of body mass index and prostate-specific antigen in a population-based study. Cancer. 2005; 103:1092–5.
crossref
21. Moyad MA. Is obesity a risk factor for prostate cancer, and does it even matter? A hypothesis and different perspective. Urology. 2002; 59:41–50.
crossref
22. Freedland SJ, Grubb KA, Yiu SK, Humphreys EB, Nielsen ME, Mangold LA, et al. Obesity and risk of biochemical progression following radical prostatectomy at a tertiary care referral center. J Urol. 2005; 174:919–22.
crossref
23. Bassett WW, Cooperberg MR, Sadetsky N, Silva S, DuChane J, Pasta DJ, et al. Impact of obesity on prostate cancer recurrence after radical prostatectomy: data from CAPSURE. Urology. 2005; 66:1060–5.
crossref
24. Freedland SJ, Giovannucci E, Platz EA. Are findings from studies of obesity and prostate cancer really in conflict? Cancer causes control. 2006; 17:5–9.
crossref
25. Stamey TA, McNeal JE, Yemoto CM, Sigal BM, Johnstone IM. Biological determinants of cancer progression in men with prostate cancer. JAMA. 1999; 281:1395–400.
crossref
26. Nelson BA, Shappell SB, Chang SS, Wells N, Farnham SB, Smith JA Jr, et al. Tumour volume is an independent predictor of prostate-specific antigen recurrence in patients undergoing radical prostatectomy for clinically localized prostate cancer. BJU Int. 2006; 97:1169–72.
crossref
27. Khandwala HM, McCutcheon IE, Flyvbjerg A, Friend KE. The effects of insulin-like growth factors on tumorigenesis and neoplastic growth. Endocr Rev. 2000; 21:215–44.
crossref
28. LeRoith D, Roberts CT Jr. The insulin-like growth factor system and cancer. Cancer Lett. 2003; 195:127–37.
crossref
29. Chan JM, Stampfer MJ, Giovannucci E, Gann PH, Ma J, Wilkinson P, et al. Plasma insulin-like growth factor-I and prostate cancer risk: a prospective study. Science. 1998; 279:563–6.
crossref

Table 1.
Patient characteristics with or without metabolic syndrome (mean±SD)
  MS group (n=75) Not MS group (n=186) p-value
Age (years) 64.8±6.2 64.4±6.8 0.946
FBS (mg/dl) 137.5±43.1 116.5±35.8 <0.001
Systolic BP (mmHg) 140.7±13.4 129.5±15.4 <0.001
Diastolic BP (mmHg) 81.9±8.5 75.6±9.1 <0.001
BMI (kg/m2) 26.8±2.1 23.6±2.3 <0.001
TG (mg/dl) 143.7±50.8 115.2±22.2 <0.001
HDL (mg/dl) 53.9±12.4 59.3±14.5 0.007
PSA (ng/ml) 10.7±9.9 9.8±7.4 0.778
Prostate size∗ (cc) 40.3±15.8 40.1±16.3 0.955
Biopsy Gleason score 6.4±0.6 6.6±0.8 0.431
Prostatectomy 6.7±0.7 6.7±0.6 0.822
Gleason score Pathologic stage     0.937
pT2 58 (77.3%) 143 (76.9%)  
≥pT3 17 (22.7%) 43 (23.1%)  

MS: metabolic syndrome, FBS: fasting blood glucose, BP: blood pressure, BMI: body mass index, TG: triglyceride, HDL: high-density lipoprotein, PSA: prostate-specific antigen. ∗measured by imaging study,

Pearson chi-square test.

Table 2.
Pathologic characteristics with or without metabolic syndrome
  MS group (n=75) Not MS group (n=186) p-value
Prostate weight (g) 39.3±12.2 39.4±13.7 0.881
Tumor volume (cc) 6.6±5.5 5.0±4.5 0.010
Extracapsular extension (%) 15 (20.0) 37 (19.9) 0.984
Seminal vesicle invasion (%) 6 (8.0) 12 (6.5) 0.655
Bladder neck invasion n (%) 5 (6.7) 9 (4.8) 0.553
Multicentricity (%) 51 (68.0) 115 (61.8) 0.348
Angiolymphatic invasion (%) 16 (21.3) 39 (21.0) 0.948
Perineural invasion (% %) 22 (29.3) 53 (28.5) 0.892

MS: metabolic syndrome.

: measured prostate weight of the prostatectomy specimen,

: Mann-Whitney U test.

Table 3.
Comparison of age, PSA, prostatectomy Gleason score, and tumor volume according to the finding of metabolic disorder in patients
  Age (years) PSA (ng/ml) Gleason score Tumor volue (cc)
Hyperglycemia
  Yes (n=142) 64.8±6.8 9.9±8.4 6.8±0.6 5.6±5.1
  No (n=119) 64.2±6.4 10.3±7.8 6.7±0.6 5.3±4.5
  p-value 0.321 0.464 0.866 0.670
Hypertension
  Yes (n=147) 64.5±6.5 10.4±8.8 6.8±0.6 5.7±4.8
  No (n=114) 64.5±6.7 9.6±7.2 6.7±0.2 5.1±4.9
  p-value2 0.881 0.627 0.454 0.068
BMI≥25kg/m2
  Yes (n=107) 65.1±6.4 11.6±10.2 6.8±0.7 6.3±5.5
  No (n=154) 64.1±6.7 9.1±6.2 6.7±0.6 4.9±4.3
  p-value 0.370 0.100 0.918 0.054
Dyslipidemia
  Yes (n=77) 64.2±5.8 10.0±7.4 6.8±0.5 6.1±5.3
  No (n=184) 64.7±6.9 10.1±8.4 6.7±0.6 5.2±4.7
  p-value 0.267 0.897 0.347 0.072

PSA: prostate-specific antigen

Table 4.
Association between prostate cancer characteristics and the number of combined metabolic disorder
  No. of metabolic disorder
0 (n=31) 1 (n=77) 2 (n=78) 3 (n=60) 4 (n=15) p-value
Age (years) 63.8±7.1 64.8±6.6 64.3±6.9 64.2±6.3 67.0±5.4 0.523
PSA (ng/ml) 8.3±5.5 9.8±7.0 10.4±8.3 10.9±10.4 10.2±7.6 0.879
Prostate weight (g) 36.9±10.1 41.6±16.4 38.1±11.7 39.5±13.4 38.8±5.8 0.775
Gleason score 6.6±0.4 6.7±0.6 6.8±0.6 6.7±0.7 6.8±0.5 0.335
 ≤6 (%) 10 (32.3) 30 (39.0) 19 (24.4) 21 (35.0) 4 (26.7)  
 ≥7(%) 23 (67.7) 47 (61.0) 59 (75.6) 39 (65.0) 11 (73.3) 0.527
Pathologic stage            
 ≤T2 (%) 27 (87.1) 56 (72.7) 60 (76.9) 45 (75.1) 13 (86.7)  
 ≥T3 (%) 4 (12.9) 21 (27.3) 18 (23.1) 15 (25.0) 2 (13.3) 0.856
Tumor volume            
 <25 percentile (%) 12 (38.7) 20 (26.0) 20 (25.6) 12 (20.0) 0 (0.0)  
 25–50 percentile (%) 3 (9.7) 21 (27.3) 23 (29.5) 14 (23.3) 3 (20.0)  
 50–75 percentile (%) 9 (29.0) 21 (27.3) 15 (19.2) 14 (23.3) 9 (60.0) 0.025
 >75 percentile (%) 7 (22.6) 15 (19.4) 20 (25.6) 20 (33.4) 3 (20.0)  

PSA: prostate-specific antigen.

linear-by-linear association

Table 5.
Multivariable analysis affecting tumor volume by linear regression model
  Odds ratio 95% CI p-value
Age 0.072 0.005–0.149 0.067
PSA 1.134 1.064–1.202 <0.001
Prostate size 0.020 0.002–0.060 0.326
Gleason score 1.081 0.235–1.928 0.012
Pathologic stage 1.109 0.726–1.491 <0.001
Metabolic syndrome 1.247 1.143–2.352 0.027

PSA: prostate-specific antigen, CI: confidence interval

TOOLS
Similar articles