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.
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.
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).
The data from our study support that metabolic syndrome is closely associated with the development and progression of prostate cancer.
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.
Pathologic characteristics with or without metabolic syndrome
| MS group (n=75) | Not MS group (n=186) | p-value | |
|---|---|---|---|
| Prostate weight |
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.
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
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
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