Do Metabolic Factors Increase Mortality in Prostate Cancer?

Hello. I am Dr. Gerald Chodak for Medscape. Today's topic is the role of metabolic syndrome in men with prostate cancer. Haggstrom and coworkers ^[1] published in Cancer a large cohort series on nearly 300,000 men who were followed over a course of about 12 years.

What they attempted to determine was whether having symptoms of metabolic syndrome was associated with an increased risk of developing prostate cancer. The authors found no such association. However, they did find that men who had metabolic syndrome were more likely to be dying from prostate cancer, the risk for which was associated with elevated body mass index, elevated blood pressure, or abnormal glucose or triglyceride blood levels.

The significance of this is the following. We know that many men who progress from prostate cancer are likely to develop metabolic syndrome as a consequence of androgen deprivation. Although we are getting better at treating men with progressive metastatic prostate cancer, the fact is that we may be falling far short of addressing potentially resolvable problems that contribute to their overall death.
I don't think that urologists are primed for evaluating patients for metabolic syndrome, monitoring it, or ensuring that patients are getting the care that they need to make sure that the syndrome is being addressed. What does that mean going forward? First, we need to alert our patients to these side effects and symptoms, encouraging them to try to moderate their weight, get exercise, monitor their glucose levels, get their blood pressure managed properly, and address triglyceride levels that may be abnormal.

That may be outside the realm of the urologist. However, it does require careful attention, and urologists need to do a better job of ensuring that their patients with progressive prostate cancer are receiving care in the area of addressing metabolic syndrome. That means that not only is better patient education needed, but physicians need to be tuned in to the seriousness of these side effects. As urologists, we tend to think more about the cancer with blinders on and don't address the peripheral association that happens as a result of the treatments that we administer.

But it is becoming clearer all the time that metabolic syndrome is serious. It contributes to the mortality of men with prostate cancer and, more than likely, there is a great opportunity for improving the management of our patients to address some of these problems. Hopefully you will find this information useful. I look forward to your comments. Thank you.