Association between serum uric acid and prostate cancer mortality in androgen deprivation therapy: A population‐based cohort study

Abstract

ObjectiveThis population‐based study examined the association between baseline uric acid (UA) and prostate cancer (PCa)‐related mortality amongst PCa patients receiving androgen deprivation therapy (ADT).MethodsAdults with PCa who received ADT in Hong Kong between December 1999 and March 2021 were identified. Patients with missing baseline UA were excluded. Patients were followed up until September 2021. The outcome was PCa‐related mortality.ResultsAltogether, 4126 patients (median follow‐up 3.1[interquartile range 1.4–6.0] years) were included. A J‐shaped association was observed between baseline UA level and PCa‐related mortality risk, with a direct association in those with mean(0.401 mmol/L) or above‐mean baseline UA levels (hazard ratio (HR) per standard deviation‐increase 1.35 [95% confidence interval 1.21,1.51], p < 0.001), and an inverse association in those with below‐mean baseline UA levels (HR 0.78[0.67,0.92], p = 0.003). The former remained significant on competing risk regression, but not the latter.ConclusionsA J‐shaped relationship between baseline UA level and PCa‐related mortality risk was identified. This study was mainly limited by potential unmeasured and residual confounders. Further validation studies are warranted.

Uric Acid Inhibits Mice Pancreatic Steatosis via the Glycerophospholipid Pathway

“…Similar studies have shown that uric acid plays dual roles; for example, moderate elevations in SUA at low concentrations can improve diabetic complications and can lead to the aggravation of diabetes. The SUA level has a “J” shaped relationship with the risk of death associated with prostate cancer with the risk of death decreasing and then increasing as SUA levels rise. High levels of SUA are protective against neurological disorders, such as Parkinson’s disease, whereas low levels are harmful. − …”

“…High uric acid levels can cause inflammation and oxidative stress, promote the death of pancreatic β-cells, and induce diabetes in male mice . However, an appropriate increase in uric acid at low concentrations may improve short-term functional outcomes of ischemic stroke in patients with type 2 diabetes and reduce the risk of death associated with prostate cancer . Moreover, at physiological concentrations, uric acid acts as an antioxidant, − scavenging oxygen radicals and exerting a protective effect on most organs, , except the nervous system .…”

“… 16 However, an appropriate increase in uric acid at low concentrations may improve short-term functional outcomes of ischemic stroke in patients with type 2 diabetes 17 and reduce the risk of death associated with prostate cancer. 18 Moreover, at physiological concentrations, uric acid acts as an antioxidant, 19 − 23 scavenging oxygen radicals and exerting a protective effect on most organs, 19 , 22 except the nervous system. 22 Several studies have shown that low uric acid levels damage the nervous system, 24 , 25 whereas high uric acid levels exert protective effects.…”

Cardiovascular disease burden in patients with urological cancers: The new discipline of uro‐cardio‐oncology

“…The long‐term effects of ADT on insulin sensitivity need further investigation. Other metabolic risk factors include raised uric acid levels [ 34 ]. Finally, in a subgroup analysis of patients with prostate cancer receiving ADT who also had diabetes, visit‐to‐visit variability in HbA1c was a significant prognostic marker [ 35 ], and metformin use was protective against adverse cardiovascular outcomes and mortality [ 36 , 37 ].…”