Metabolic syndrome in men following radical prostatectomy (RP) for prostate cancer is associated with an increased risk for prostate cancer-specific mortality and development of castration-resistant prostate cancer (CRPC), according to study findings presented at the AUA2021 Virtual Experience.

“If confirmed, managing metabolic syndrome components may reduce CRPC and prostate-cancer specific mortality risks in prostate cancer patients,” said investigator Tyler R. Erickson, MS, of the Durham VA Health Care System in Durham, North Carolina, who presented study findings.

The study, which was led by Adriana C. Vidal, PhD, of Cedars-Sinai Medical Center in Los Angeles, California, included 4587 men who underwent RP for prostate cancer at 8 Veterans Affairs (VA) medical centers from 2007 to 2017. Of these, 1605 (35%) had metabolic syndrome at the time of surgery and 2982 (65%) did not. During follow-up, biochemical recurrence developed in 30% of men, metastasis in 3.6%, and CRPC in 2.4%. Another 16% died and 1.7% died from prostate cancer.

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Metabolic syndrome was significantly associated with 57% and 94% increased risks for CRPC and death from prostate cancer, respectively, after adjusting for demographic, pathologic, and other characteristics, according to the investigators.

Dr Vidal and colleagues found no association between metabolic syndrome and the risk for biochemical recurrence, metastasis, or all-cause mortality.

The investigators defined metabolic syndrome as the presence of 3 of 5 components: hypertension (systolic blood pressure (BP) greater than 130 mm Hg or diastolic BP greater than 85 mm Hg), obesity (body mass index greater than 30 kg/m2), high triglycerides (150 mg/dL or higher), low high-density lipoprotein (less than 40 mg/dL), and diabetes. The racial composition of the patients with and without metabolic syndrome were similar.

“The study generates an interesting hypothesis that metabolic syndrome does not impact the risk of developing biochemical recurrence or metastasis after radical prostatectomy, but does increase the risk of developing castration-resistant metastatic disease and the risk of death from prostate cancer,” said urologic oncologist Keyan Salari, MD, PhD, co-director of the Prostate Cancer Genetics Program at Massachusetts General Hospital, who was not involved in the study. “This suggests there may metabolic factors at play in promoting the transition from the castration-sensitive to castration-resistant disease state.”

Dr Salari added, “If the findings are confirmed in additional studies, this would provide a strong rationale for aggressively treating components of metabolic syndrome in patients with metastatic prostate cancer with the goal of preventing progression to castration resistance. Further investigation of the mechanism of this observed effect might also lead to new therapeutic strategies for this disease state.”


Wong JE, Erickson TR, Howard LE, et al. Metabolic syndrome and long-term prostate cancer outcomes after radical prostatectomy. Presented at: AUA 2021, held September 10-13, 2021. Poster MP32-18.