title: Risk of prostate cancer-specific death in men with baseline metabolic aberrations treated with androgen deprivation therapy for biochemical recurrence.
abstract: OBJECTIVE
  To investigate the associations of host metabolic factors and metabolic syndrome on prostate cancer-specific death (PCSD) and overall survival (OS) in patients treated with androgen deprivation therapy (ADT) for biochemically recurrent disease.
  
  
  METHODS
  The analysis included 273 patients with prostate cancer treated with ADT for rising prostate-specific antigen level after surgery or radiotherapy. Patients were assessed for the presence of diabetes, hypertension, dyslipidaemia and obesity before commencing ADT, and Adult Treatment Panel III criteria were used to assess the presence of the composite diagnosis of metabolic syndrome. A competing risks regression model was used to assess associations of time to PCSD with the metabolic conditions, while a multivariable Cox regression model was used to assess associations of OS with metabolic syndrome and metabolic conditions.
  
  
  RESULTS
  During a median follow-up of 11.6 years, 157 patients (58%) died, of whom 58 (21%) died from prostate cancer. At the start of ADT the median (range) patient age was 74 (46-92) years and the median PSA level was 3.0 ng/mL. Metabolic syndrome was observed in 31% of patients; hypertension (68%) and dyslipidaemia (47%) were the most common metabolic conditions. No association of PCSD and metabolic syndrome status was observed. Patients with hypertension tended to have a higher cumulative incidence of PCSD than those without hypertension (sub-distribution hazard ratio [HR] 1.59, 95% confidence interval [CI] 0.89, 2.84; P = 0.11) although the difference was not statistically significant. Patients with metabolic syndrome had an increased risk of death from all causes (HR 1.56, 95% CI 1.07, 2.29; P = 0.02) when compared with patients without metabolic syndrome, as did patients with hypertension (HR 1.72, 95% CI 1.18, 2.49; P = 0.004).
  
  
  CONCLUSIONS
  No association of PCSD and metabolic syndrome was observed in this cohort of men receiving ADT for biochemically recurrent prostate cancer. Metabolic syndrome was associated with an increased risk of death from all causes and a similar effect was also observed for patients with prostate cancer with hypertension alone.
authors.affiliation: Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Rudman
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Gray
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Batista
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pitt
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.|Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.|Center for Molecular Oncologic Pathology, Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Giovannucci
authors.affiliation: Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Harper
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Massimo
authors.initials: M
authors.lastname: Loda
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, Boston, MA, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Lorelei A
authors.initials: LA
authors.lastname: Mucci
authors.affiliation: Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000150:complications; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D018570:Risk Assessment
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
keywords: androgen deprivation therapy; biochemical recurrence; competing risks; hypertension; metabolic syndrome; prostate cancer