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A stage-dependent link between metabolic syndrome components and incident prostate cancer

Nature Reviews Urology volume 15, pages 321–333 (2018)Cite this article

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Abstract

Metabolic syndrome is associated with increased cancer risk and progression at almost all sites, including the prostate in high-stage prostate cancer. However, several reports have described an inverse relationship between metabolic syndrome and its components and low-stage incident prostate cancer. Such anomalies in cancer research hamper efforts to fight cancer. Evidence suggests that metabolic syndrome and its components have two distinct effects in prostate cancer, concealing prostate cancer in low-stage disease and promoting progression to high-stage incident, nonlocalized, and lethal prostate cancer. The concealment of prostate cancer by metabolic syndrome and its components might be related to bias mechanisms that reduce PSA level and lead to a delayed diagnosis of low-stage prostate cancer, meaning that fewer men with metabolic syndrome are diagnosed with low-stage disease. The inverse link between metabolic syndrome and its components and low-stage incident prostate cancer might simply be the result of such bias and the shortcomings of the diagnostic procedure rather than being related to prostate cancer biology itself. The evidence summarized here supports the hypothesis that the link between metabolic syndrome and its components and incident prostate cancer is a two-way and stage-dependent one, a theory that requires further research.

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Figure 1: Potential mechanisms to explain different associations between metabolic syndrome and its components and high-stage and low-stage incident prostate cancer.
Figure 2: Associations between fasting plasma insulin levels and prostate cancer.

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Authors and Affiliations

  1. Mohammad A. Haghsheno and Ralph Peeker are at the Department of Urology, Jan Hammarsten, Jan-Erik Damber, Institute of Clinical Sciences, University of Gothenburg, Bruna stråket 11 B, SE-413 45 Göteborg, Sweden.,

    Jan Hammarsten, Jan-Erik Damber, Mohammad A. Haghsheno & Ralph Peeker

  2. Department of Internal Medicine and Clinical Nutrition, Dan Mellström is at Geriatric Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden, and at Geriatric Medicine, Institute of Medicine, The Sahlgrenska Academy, Building K, 6th Floor, Sahlgrenska University Hospital, Mölndal, SE-431 80 Mölndal, Sweden.,

    Dan Mellström

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J.H. performed the research and wrote the manuscript. J.-E.D., M.H., D.M., and R.P. reviewed and edited the article before submission.

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Correspondence to Jan Hammarsten.

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Hammarsten, J., Damber, JE., Haghsheno, M. et al. A stage-dependent link between metabolic syndrome components and incident prostate cancer. Nat Rev Urol 15, 321–333 (2018). https://doi.org/10.1038/nrurol.2018.8

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