title: Metabolic syndrome, dyslipidemia and prostate cancer recurrence after primary surgery or radiation in a veterans cohort.
abstract: BACKGROUND
  Metabolic syndrome (MetS) has been hypothesized to be associated with cancer, including prostate cancer (PCa), but the relationship is not well characterized. We analyze the relationship between MetS features and localized PCa recurrence after treatment.
  
  
  METHODS
  Men having primary treatment for localized PCa were included from a multi-site regional veteran network. Recurrence was defined as nadir PSA +2 ng ml(-1) (radiation) or PSA⩾0.2 ng ml(-1) (prostatectomy). MetS was based on consensus professional society guidelines from the American Heart Association and International Diabetes Federation (three of: hypertension >130/85 mm Hg, fasting blood glucose ⩾100 mg dl(-1), waist circumference >102 cm, high-density lipoprotein <40 mg dl(-1), triglycerides ⩾150 mg dl(-1)). Closely related abnormality in low-density lipoprotein (LDL; >130 mg dl(-1)) was also examined. Analysis of PCa recurrence risk included multivariable Cox proportional hazards regression with propensity adjustment.
  
  
  RESULTS
  Of the 1706 eligible men, 279 experienced recurrence over a median follow-up period of 41 months (range 1-120 months). Adjustment variables associated with PCa recurrence included: index PSA, Gleason, and tumor stage. Independent variables of interest associated with PCa recurrence were hyperglycemia and elevated LDL. Elevated LDL was associated with PCa recurrence (multivariable hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.03, 1.74; propensity adjusted HR 1.33, 95% CI 1.03, 1.72). There was also an association between impaired fasting glucose and PCa recurrence in (multivariable HR 1.54, 95% CI 1.10, 2.15; propensity adjusted HR 1.41, 95% CI 1.01, 1.95). MetS was not associated with PCa recurrence (multivariable: HR 0.96, 95% CI 0.61, 1.50; propensity adjusted HR 1.04, 95% CI 0.67, 1.62).
  
  
  CONCLUSIONS
  PCa recurrence is not associated with MetS but is associated with elevated LDL and impaired fasting glucose. If confirmed, these data may help provide modifiable targets in preventing recurrence of PCa.
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Macleod
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Chery
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: E Y C
authors.initials: EY
authors.lastname: Hu
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Zeliadt
authors.affiliation: Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Holt
authors.affiliation: 1] Department of Urology, University of Washington School of Medicine, Seattle, WA, USA [2] Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA [3] Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Lin
authors.affiliation: 1] Department of Urology, University of Washington School of Medicine, Seattle, WA, USA [2] Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Porter
authors.affiliation: 1] Department of Urology, University of Washington School of Medicine, Seattle, WA, USA [2] Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Gore
authors.affiliation: 1] Department of Urology, University of Washington School of Medicine, Seattle, WA, USA [2] Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA [3] Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Wright
mesh_terms: D000368:Aged; D001786:Blood Glucose; D050171:Dyslipidemias / Q000097:blood / Q000473:pathology*; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D014481:United States; D014728:Veterans
chemical_list: D001786:Blood Glucose; D008077:Lipoproteins, LDL; D017430:Prostate-Specific Antigen
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