High-Grade Prostate Cancer Linked to Elevated Cardiovascular Risk

Among men with PCa found on biopsy, those with moderate or high cardiovascular risk are twice as likely to have Gleason 7 or higher tumors.
Among men with PCa found on biopsy, those with moderate or high cardiovascular risk are twice as likely to have Gleason 7 or higher tumors.

Men who have prostate cancer (PCa) found on biopsy are more likely to have a high-grade Gleason score if they are at moderate or high cardiovascular risk (CVR), according to Italian investigators.

In a prospective study, Cosimo De Nunzio, MD, of Ospedale Sant'Andrea, Sapienza University of Rome, and colleagues enrolled 584 men who underwent 12-core prostate biopsies. Of these, 406 (70%) had moderate or high CVR and 237 (40.6%) had PCa found on biopsy. The PCa group included 157 patients with moderate or high CVR and 80 with low or no CVR, a non-significant difference.

Of the 237 patients with PCa, 113 had a Gleason score of 6 and 124 had a Gleason score of 7 or higher. Ninety-two (75%) of the 124 patients had a moderate or high CVR.

Moderate or high CVR was not associated with PCa risk overall, but was associated with a significant 2.1 times increased risk of having Gleason 7 or higher disease, Dr. De Nunzio and his colleagues reported online ahead of print in Prostate Cancer and Prostatic Diseases.

The investigators defined CVR on the basis of the following risk factors: systolic and diastolic blood pressure (BP), high-density lipoprotein and triglyceride levels, glycemia, abdominal obesity, and family history of premature cardiovascular disease. Patients with grade 2 hypertension (160/100 mm Hg) or higher, those with grade 1 hypertension (systolic BP 140–159 mm Hg or diastolic BP 90–99 mm Hg) and 1–2 risk factors, or patients with 3 or more risk factors apart from blood pressure were considered to have moderate or high CVR.

Of the 584 study subjects, 223 (38.1%) had metabolic syndrome as defined according to the Adult Treatment Panel III. Among the PCa patients, metabolic syndrome was significantly more prevalent among men with Gleason score 7 or higher tumors than Gleason score 6 tumors (50.8% vs. 32.7%).

In their acknowledgement of study limitations, the researchers noted that their study was conducted at a single-center with a limited population of patients and a significant number of patients with moderate or high CVR. In addition, they noted that their results apply only to their study cohort, that is, men undergoing prostate biopsy, and cannot be extrapolated to all patients at risk for PCa.

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