Quantifying the Evidence for the Risk of Metabolic Syndrome and Its Components following Androgen Deprivation Therapy for Prostate Cancer: A Meta-Analysis

Abstract

BackgroundNo meta-analysis is yet available for the risk of metabolic syndrome (MetS) following androgen deprivation therapy (ADT) for men with prostate cancer. To summarize the evidence for the link between ADT and MetS or its components quantitatively with a meta-analysis including all studies published to date.MethodsPubMed and Embase were searched using predefined inclusion criteria to perform meta-analyses on the association between metabolic syndrome, hyperglycemia, diabetes, hypertension, dyslipidemia or obesity and androgen deprivation therapy in patients with prostate cancer. Random effects methods were used to estimate pooled relative risks (RRs) and 95% confidence intervals (CI).ResultsA total of nine studies was included. There was a positive association between ADT and risk of MetS (RR: 1.75 (95% CI: 1.27–2.41)). Diabetes was the only MetS component present in more than 3 studies, and also showed an increased risk following ADT (RR: 1.36 (95% CI: 1.17–1.58)).ConclusionThis is the first quantitative summary addressing the potential risk of MetS following ADT in men with PCa. The positive RRs indicate that there is a need to further elucidate how type and duration of ADT affect these increased risks of MetS and diabetes as the number of men with PCa treated with ADT is increasing.

Metformin as an adjuvant treatment for cancer: a systematic review and meta-analysis

“…Metabolic syndrome is also known to increase the risk of developing some cancers, particularly colorectal cancer [67], where it is also associated with poorer recurrence and survival outcomes [68]. In addition, it is known to develop as a consequence of androgen deprivation therapy in men with prostate cancer [69]. Metformin may improve OS by reducing the number of cardiovascular deaths associated with metabolic syndrome; however, the improvements in RFS and CSS identified suggest a direct anti-cancer effect.…”

American Brachytherapy Society Task Group Report: Use of androgen deprivation therapy with prostate brachytherapy—A systematic literature review

“…Cognitive dysfunction and depression have also been documented (41) where up to 27% of patients on ADT may suffer psychiatric illness during their treatment (42). As experience grew, the more ominous systemic and metabolic effects were documented (43). There is an increased risk of osteoporosis with 23% increase in incidence of fractures.…”

SIMBOSPROST: Prevalence of metabolic syndrome and osteoporosis in prostate cancer patients treated with radiotherapy and androgen deprivation therapy: A multicentre, cross-sectional study

“…While the worldwide prevalence of MetS in the general population is estimated to range from 20% to 30%, 4 MetS prevalence is reported to be approximately 50% in PCa patients treated with ADT. 5 Rates of osteoporosis are also higher in this patient population (35.4-49.2%) versus the general population. 6,7 In most cases of PCa, the disease progresses relatively slowly, even without treatment.…”

“…[11][12][13] As a result, the long-term association between MetS, osteoporosis, and ADT remains controversial and poorly understood, as a recently reported meta-analysis found. 5 …”