Is metabolic syndrome a risk factor for suboptimal response to ADT?


Metabolic syndrome has been implicated in the development of prostate cancer, but there have been no published data on whether it affects the effectiveness of androgen deprivation therapy (ADT).

Metabolic syndrome is a combination of medical conditions (including obesity, insulin resistance, pre-diabetes, hypertension and high lipid levels) that are known to increase the risk of developing cardiovascular disease and adult onset (Type II) diabetes. It is believed to affect 20-25 percent of the US population, and prevalence increases with age.

Flanagan et al. carried out a retrospective analysis of data from prostate cancer patients seen between 1998 and 2005 at a medical oncology clinic. The presence or absence of metabolic syndrome in these patients (as defined by modified Adult Treatment Panel III criteria) was assessed among these patients at the time of initiation of ADT. The study end points were time to PSA progression and overall survival (OS) from time of starting ADT.

The authors report the following findings:

  • 82 patients treated with ADT were identified whose data allowed their assessment for presence of metabolic syndrome at the time of initiation of ADT.
  • The average (median) age of the 82 patients (with and without metabolic syndrome) was 70 years.
  • 40/82 patients (49 percent met criteria for metabolic syndrome.
  • The average (median) time to PSA progression for patients with metabolic syndrome was 16 months.
  • The average (median) time to PSA progression for patients without metabolic syndrome was 36 months.
  • The average (median) OS for patients with metabolic syndrome was 36.5 months from initiation of ADT.
  • The average (median) OS for patients without metabolic syndrome was 46.7 months from time of initiation of ADT.

In the opinion of Flanagan et al., these data suggest that metabolic syndrome may be a risk factor for earlier development of castration-resistant prostate cancer, and support the need for a prospective clinical study to validate this hypothesis.

It is also interesting to speculate whether there is some connection between this possibility and the supposed increase in risk for cardiovascular side effects associated with the clinical use of ADT.

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