Features of the impact of metabolic syndrome on the prostate cancer aggressiveness
Summary. The purpose of the study was to investigate the specifics of the clinical and morphological course of prostate cancer (PCa) in patients with metabolic syndrome (MS) and its influence on the spread of the metastatic process. Materials and methods. The study included 79 patients with locally advanced PCa who underwent inpatient treatment in the period from 2015 to 2020 in plastic and reconstructive department of National cancer institute of Ukraine and undergo further outpatient observation, diagnosis and treatment during the time before the development of bone metastasis (BM) from the moment of radical prostatectomy (RP), among which MS was diagnosed in 40 (50.6%) and absent in 39 (49.4%). The average age of the patients was: 69 (59–80) years. Patients participated in the study with existing MS were divided into 2 studied groups: 17 (21.5%) with moderate risk (Grade group 2, 3) and 23 (29.1%) with high risk (Grade group 4, 5) of disease progression, in contrast to patients without MS: 20 (25.3%) with Grade group 2, 3 and 19 (24.1%) with Grade group 4, 5. The average initial level of total PSA in patients with MS and Grade group 2, 3 was: 16.35 ng/ml, Grade group 4, 5 — 23.75 ng/ml. In patients without MS with Grade group 2, 3 — 14 ng/ml, Grade group 4, 5 — 21.45 ng/ml. Results. Among 79 study participants, after RP, 35 (44.3%) were diagnosed with the development of bone and visceral metastases, in contrast to 44 (55.7%) without metastases. Among 35 patients with the development of BM — 27 (77.1%) with MS, 8 (22.9%) — no signs of MS. BM was combined with visceral metastases in 17 (48.5%) patients, MS was found in most cases of this cohort of 11 (64.7%) patients. BM in the subgroup of moderate risk (Gleason 7 (3+4, 4+3) of 37 patients developed in 12 (32.4%) remained and in 25 (67.6%) BM was absent. The ratio of the presence of MS was as follows: 7 (18.9%) to 5 (13.5%). Analyzing a subgroup of 42 high-risk patients (Gleason 8, 9), BM was present in 23 (54.7%) and absent in 19 (45.3%), respectively, the present MS was observed in 20 (47.6%) and 9 (21.4%) cases. The average initial indicators of the PSA in the subgroup of moderate risk (Gleason 3+4, 4+3) of patients with BM and existing MS was 16.35 (14.1–18.9) ng/ml, in patients without MS 14.05 (12.7– 18.6) ng/ml. The level of AF (alkaline phosphatase) at the time of development of BM in substitution with MS — 233.55 (214–240) Units/l, without MS — 230.85 (212–237) Units/l. Calcium indicators with MS — 2.47 (2.41–2.52) mmol/l and without MS — 2.34 (2.29– 2.41). Hemoglobin indicators were significantly reduced in patients with BM and MS — 93.85 (91–94) g/l, in the absence of MS — 95.45 (93–99) g/l. High-risk subgroup patients (Gleason 8, 9), initial indicators of the PSA with BM and present MS 23.75 (20–28.1) ng/ml, with absent MS 21.45 (19.8– 24.4) ng/ml, which is an indicator of aggressive differentiation of adenocarcinoma and aggressive course of the disease. The level of AF in patients with BM and positive MS — 244.8 (235–250) U/l, without MS — 237.4 (223–252) U/l. Calcium indicators with MS — 2.67 (2.62–2.75) mmol/l and without MS — 2.61 (2.48–2.69). Hemoglobin indicators were low in patients with BM with presence of MS — 90.35 (86–99) g/l, with no MS — 96 (90–102) g/l. Conclusions. Clinical and laboratory diagnostics of the development of BM of PCa is an actual method of monitoring the course of PCa in modern clinical practice. The presence of MS in patients with PCa contributes to an aggressive course of the disease with the development of BM in patients with a moderate and high risk of progression compared to patients without MS. Patients with existing MS should be separated into different groups of patients who are predicted to have a more aggressive course of the disease and, as a result, a worse survival prognosis. A personalized approach to the diagnosis and treatment of patients with PCa with MS will increase the duration and quality of life of PCa patients.
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