Clinical association of metabolic syndrome, C-reactive protein and testosterone levels with clinically significant prostate cancer.

Enrique Gómez‐Gómez,Julia Carrasco‐Valiente,Juan Pablo Campos‐Hernández,Ana Maria Blanca‐Pedregosa,María José Requena‐Tapia,Jesus Ruiz‐García,Raul Miguel Luque,Jose Valero‐Rosa,Juan Manuel Jiménez‐Vacas

doi:10.1111/jcmm.13994

Abstract

Recently, the influence that metabolic syndrome (MetS), hormonal alterations and inflammation might have on prostate cancer (PCa) risk has been a subject of controversial debate. Herein, we aimed to investigate the association between MetS‐components, C‐reactive protein (CRP) and testosterone levels, and the risk of clinically significant PCa (Sig‐PCa) at the time of prostate biopsy. For that, men scheduled for transrectal ultrasound guided biopsy of the prostate were studied. Clinical, laboratory parameters and criteria for MetS characterization just before the biopsy were collected. A total of 524 patients were analysed, being 195 (37.2%) subsequently diagnosed with PCa and 240 (45.8%) meet the diagnostic criteria for MetS. Among patients with PCa, MetS‐diagnosis was present in 94 (48.2%). Remarkably, a higher risk of Sig‐PCa was associated to MetS, greater number of MetS‐components and higher CRP levels (odds‐ratio: 1.83, 1.30 and 2.00, respectively; P < 0.05). Moreover, higher circulating CRP levels were also associated with a more aggressive Gleason score in PCa patients. Altogether, our data reveal a clear association between the presence of MetS, a greater number of MetS‐components or CRP levels >2.5 mg/L with an increased Sig‐PCa diagnosis and/or with aggressive features, suggesting that MetS and/or CRP levels might influence PCa pathophysiology.

Highlights

Prostate cancer (PCa) is the most common cancer among men in developed countries and a leading cause of mortality and morbidity globally.[1]
It has been suggested that low levels of testosterone could be linked with the presence of abdominal obesity, and this in turn, might cause an alteration in the metabolism of fatty acids promoting insulin resistance,[9] which might be associated to PCa risk[10,11]; the association between circulating testosterone levels, metabolic status and PCa progression/aggressiveness remains controversial.[12–15]
Current evidence suggests that metabolic syndrome (MetS) could play a role in the development and progression of several neoplasms, including PCa.[6,21]

Summary

| INTRODUCTION

Prostate cancer (PCa) is the most common cancer among men in developed countries and a leading cause of mortality and morbidity globally.[1]. Several mechanisms have been proposed to explain the association between PCa and MetS including hormonal alterations (eg low circulating levels of testosterone), insulin resistance (eg high insulin and IGF‐1 levels) and inflammation status (eg alterations in cytokines and C‐reactive protein [CRP] levels, among others inflammatory‐ related molecules).[6] In this sense, we have recently uncovered the existence of a fine, germane crosstalk between the endocrine‐metabolic status and the development and homoeostasis of the prostate gland, wherein key components of the insulin, IGF1 and adipokines axes, among other, could play a relevant pathophysiological role.[7,8]. All the analyses and graphics were performed with GraphPad prism 6, MedCalc statistical software and SPSS version 17.0

| RESULTS

Findings

| DISCUSSION