"Impact of Metabolic Syndrome on Prostate Cancer Diagnosis and Grade in Chinese Patients Undergo

• Abstract
• Objective: Biologic rationale exists for the association between Metabolic Syndrome (MS) and prostate cancer. However, epidemiologic studies have been conflicting. This study aimed to evaluate the association between MS and prostate cancer diagnosis and grade in Chinese patients undergoing prostate biopsy.
• Methods: An observational study was conducted of 890 men who underwent prostate biopsy from two Chinese clinical centers. MS was defined according to the Adult Treatment Panel Ⅲ criteria. Clinicopathological factors including age, PSA, DRE, prostate volume, Body Mass Index (BMI), waist circumference, blood pressure, fasting blood sugar level, lipid profiles, and MS were considered for analysis.
• Results: 890 patients were enrolled with a median age and PSA of 67.5 years and 14.44 ng/ml respectively. 247 patients (27.75%) had MS and 404 patients (45.39%) were diagnosed with prostate cancer. Age, PSA, prostate volume, DRE, BMI and MS were significant predictors for prostate cancer detection. Out of 404 patients with prostate cancer, 200 (49.5%) had Gleason score≥4+3, which include 79(39.5%) had MS. PSA, BMI, and MS were significantly associated with an increased risk of high-grade prostate cancer.
• Conclusion: Presence of MS was associated with a significantly increased risk of diagnosis of overall and high-grade prostate cancer. However, these results need to be evaluated in large-scale prospective cohorts.
• Introduction: Prostate cancer remains the most common non-skin cancer and is the second leading cause of cancer-related deaths among men in developed countries [1]. Although the pathogenesis of prostate cancer has multiple causes, the only established risk factors are age, race and family history. Since prostate cancer incidence rates in Asian men are 10 to 15 times lower than those observed in western countries but appear to be increasing rapidly as this region has gradually begun embracing the western lifestyle, which include excess calorie intake and sedentary living habits. Large epidemiological studies suggest that lifestyle factors may contribute to the etiology and progression of the disease [2]. Metabolic Syndrome (MS) is cluster of risk factors for cardiovascular and metabolic complications, including visceral obesity, hypertension, dyslipidemia and hyperglycemia, each of which have been implicated in prostate cancer carcinogenesis.Current clinical research on MS and prostate cancer is still discordant and has failed to determine the real impact of MS and/or of its individual component, on prostate cancer incidence and progression. Most of the cohort studies of overall prostate cancer incidence on European populations have demonstrated a positive association [3,4]; However, similar studies performed on American populations revealed null [5] or even inverse [6] associations. Furthermore, some studies did not find an association between MS and prostate cancer detection but found an association with high-grade prostate cancer [7] or low-grade prostate cancer [8]. Given the inconsistency of existing information, as well as tumor heterogeneity in patients of different ethnic backgrounds, the aim of this research was to investigate whether there is a relationship between MS and prostate cancer in a Chinese population who underwent a trans rectal ultrasound-guided prostate biopsy.
• Conclusions

The results of our study suggest that MS is highly prevalent in a prostate biopsy population. Age, PSA, positive DRE, prostate volume, BMI, and MS were significant predictors for prostate cancer diagnosis. Furthermore, PSA, BMI, and MS were significantly associated with an increased risk of high-grade prostate cancer. Therefore, the presence of MS was significantly associated with not only an increased prostate cancer risk but also a higher risk of high-grade disease. Further studies in a large patient population across multiple institutions and countries are needed to clarify which exact factors involved in the MS are responsible for the observed increase in prostate cancer and how these effects are mediated at a molecular level.

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