title: Metabolic syndrome is associated with advanced prostate cancer in patients treated with radical retropubic prostatectomy: results from a multicentre prospective study.
abstract: Prostate cancer (PCa) is the most common non-skin cancer in USA and the second leading cause of cancer death in Western Countries. Despite the high mortality associated with PCa, the only established risk factors are age, race and family history. A possible association between metabolic syndrome (MetS) and PCa was firstly described in 2004 and several subsequent studies in biopsy cohorts have shown conflicting results. Aim of our multicentre prospective study was to investigate the association between MetS and PCa in men undergoing radical prostatectomy (RP).
  
  
  
  From January 2012 to June 2015, 349 consecutive men undergoing RP for PCa at three centres in Italy were enrolled into a prospective database. Body Mass Index (BMI) as well as waist circumference was measured before RP. Blood samples were also collected and tested for total PSA, fasting glucose, triglycerides and HDLs. Blood pressure was also recorded. We evaluated the association between MetS, defined according to Adult Treatment Panel III, PCa stage (advanced stage defined as pT ≥ 3 or N1) and grade (high grade defined as Gleason Score ≥ 4 + 3) using logistic regression analyses.
  
  
  
  Median age and preoperative PSA levels were 66 years (IQR: 61-69) and 7 ng/ml (IQR: 5-10), respectively. Median BMI was 26.12 kg/m(2) (IQR 24-29) with 56 (16 %) obese (BMI ≥ 30 kg/m(2)) patients and 87 (25 %) patients with MetS. At pathological evaluation, advanced PCa and high-grade disease were present in 126 (36 %) and 145 (41.5 %) patients, respectively. MetS was significantly associated with advanced PCa (45/87, 51 % vs 81/262, 31 %; p = 0.008) and high-grade disease (47/87, 54 % vs 98/262, 37 %; p = 0.001). On multivariable analysis, MetS was an independent predictor of pathological stage ≥ pT3a or N1 (OR: 2.227; CI: 1.273-3.893; p = 0.005) and Gleason score ≥ 4 + 3 (OR: 2.007, CI: 1.175-3.428; p = 0.011).
  
  
  
  We firstly demonstrated in a European radical retropubic prostatectomy cohort study that MetS is associated with an increased risk of high-grade and advanced prostate cancer. Further studies with long term follow-up should evaluate the impact of Mets on PCa survival.
authors.affiliation: Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy. cosimodenunzio@virgilio.it.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.|Department of Urology, "San Giovanni Bosco" Hospital, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Simone
authors.affiliation: Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Brassetti
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Mastroianni
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.|Department of Urology, "San Giovanni Bosco" Hospital, Turin, Italy.
authors.forename: Devis
authors.initials: D
authors.lastname: Collura
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.|Department of Urology, "San Giovanni Bosco" Hospital, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muto
authors.affiliation: Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gallucci
authors.affiliation: Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000368:Aged; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D008078:Cholesterol, LDL; D014280:Triglycerides; D017430:Prostate-Specific Antigen; D005947:Glucose
keywords: High grade; Metabolic syndrome; Prostate; Prostate cancer