Metabolic syndrome is associated with PSA biochemical recurrence after radical prostatectomy: a prospective study with a minimum 5-year follow-up

Abstract

Purpose Prostate cancer exhibits significant heterogeneity in terms of its aggressiveness. The precise role of metabolic syndrome in this variability remains unclear. This study will investigate the relationship between metabolic factors and their potential role in predicting the aggressiveness of prostate cancer. Methods This was a prospective study, enrolling consecutive patients undergoing radical prostatectomy. A comprehensive metabolic profile was established by measuring weight, height, body mass index, waist circumference, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and fasting glucose, as well as by recording the presence of hypertension, diabetes mellitus and metabolic syndrome. The minimum follow-up was five years after surgery. Aggressive prostate cancer was defined based on based on three criteria: post-operative Gleason score (GS) of 8 or higher, pT3 disease classification according to the TNM staging system, and PSA biochemical recurrence after surgery. Results In total, 91 patients were enrolled. The mean age and PSA were 64.8 years and 9.3 ng/dl, respectively. The median post-operative GS was 7. The median body mass index and waist circumference was 28.3 kg/m² and 93 cm, respectively. Almost one third (29.6%) of the participants had metabolic syndrome. Waist circumference was associated positively with post-operative Gleason first grade (p = 0.041), while metabolic syndrome was associated positively with pT3 disease (p = 0.005). Kaplan-Meier analysis also revealed that patients with metabolic syndrome had significantly more likelihood for biochemical recurrence after radical prostatectomy (p = 0.025). Conclusion The current study observed a significant correlation between metabolic syndrome and aggressive prostate cancer characteristics within a cohort of patients undergoing radical prostatectomy. Therefore, patients with metabolic syndrome should be carefully observed after radical prostatectomy, as they seem to be at higher risk for recurrence.