title: Metabolic syndrome-like components and prostate cancer risk: results from the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study.
abstract: OBJECTIVE
  To evaluate the relationship between number of metabolic syndrome (MetS)-like components and prostate cancer diagnosis in a group of men where nearly all biopsies were taken independent of prostate-specific antigen (PSA) level, thus minimising any confounding from how the various MetS-like components may influence PSA levels.
  
  
  METHODS
  We analysed data from 6426 men in the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) study with at least one on-study biopsy. REDUCE compared dutasteride vs placebo on prostate cancer risk among men with an elevated PSA level and negative pre-study biopsy and included two on-study biopsies regardless of PSA level at 2 and 4 years. Available data for MetS-like components included data on diabetes, hypertension, hypercholesterolaemia, and body mass index. The association between number of these MetS-like components and prostate cancer risk and low-grade (Gleason sum <7) or high-grade (Gleason sum >7) vs no prostate cancer was evaluated using logistic regression.
  
  
  RESULTS
  In all, 2171 men (34%) had one MetS-like component, 724 (11%) had two, and 163 (3%) had three or four. Men with more MetS-like components had lower PSA levels (P = 0.029). One vs no MetS-like components was protective for overall prostate cancer (P = 0.041) and low-grade prostate cancer (P = 0.010). Two (P = 0.69) or three to four (P = 0.15) MetS-like components were not significantly related to prostate cancer. While one MetS-like component was unrelated to high-grade prostate cancer (P = 0.97), two (P = 0.059) or three to four MetS-like components (P = 0.02) were associated with increased high-grade prostate cancer risk, although only the latter was significant.
  
  
  CONCLUSIONS
  When biopsies are largely PSA level independent, men with an initial elevated PSA level and a previous negative biopsy, and multiple MetS-like components were at an increased risk of high-grade prostate cancer, suggesting the link between MetS-like components and high-grade prostate cancer is unrelated to a lowered PSA level.
authors.affiliation: Urology Section, Veterans Affairs Medical Center, Durham, NC, USA; Division of Urology, Department of Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Katharine N
authors.initials: KN
authors.lastname: Sourbeer
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Howard
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Moreira
authors.forename: Ramiro
authors.initials: R
authors.lastname: Castro-Santamaria
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Vidal
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use; D000368:Aged; D001378:Azasteroids / Q000627:therapeutic use; D001706:Biopsy; D004311:Double-Blind Method; D000068538:Dutasteride; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors
chemical_list: D058891:5-alpha Reductase Inhibitors; D001378:Azasteroids; D017430:Prostate-Specific Antigen; D000068538:Dutasteride
keywords: metabolic syndrome; prostate cancer; prostate-specific antigen