Metabolic syndrome is one of today’s most important health problems. Due to increased prevalence of metabolic syndrome in society, studies done on this topic have increased in number. Although metabolic syndrome was previously considered to be important only for cardiovascular health, it has been learned that with new data, human health is compromised more thoroughly by metabolic syndrome and is also a danger to malignancy. As a result, a new definition in the form of metabesity has been introduced. In this review, available information on metabesity and urological cancers is presented.
Figure 1 | Relationship Between Obesity and Metabesity
Table 1 | Diagnostic criteria of metabolic syndrome 6
Although metabolic syndrome is generally perceived as an important health problem regarding cardiovascular health, with the concept of metabesity more comprehensive definition has been targeted. Regardless of the name, the most common urological problem associated with this clinical picture was erectile dysfunction. However, various studies performed have detected an association between metabolic syndrome and infertility, stone disease, overactive bladder, female urinary incontinence, benign prostatic hyperplasia, prostate cancer and renal cancer. 9-11 In the light of the data obtained, the association between metabolic syndrome, and development of malignity has attracted attention of many researchers. In a recent review article this issue has been analyzed in detail.12 In the presence of metabolic syndrome, though very precise data concerning the mechanisms which lead to development of cancer have not been available13,14 some information about the role of obesity on the cancerogenesis have been obtained (Figure 2).15 In this review, the relationship between metabesity, and urologic malignancies will be presented in the light of international literature.
Figure 2 | Association Between Obesity, and Malignancy
1. Renal Cancer
Clear-cut data are not available about which metabolic syndrome component(s) is/are effective on the development of renal cancer associated with metabesity. In various studies the impact of obesity has been indicated.15-22 Some authors also reported effectiveness of diabetes mellitus and hypertension in their studies.17,22-25 Development of renal cancer due to these conditions has been associated with inflammation, insulin, and insulin-like growth factor-1, renal hypoxia, hyperfiltration, and lipid peroxidation.11,26
However in a study performed by Haggstrom et al.27 all components of metabolic syndrome have been correlation with the development of renal cancer. Increased body mass index, hypertension, hyperglycemia and hypertriglyceridemia especially in men and increased body mass index especially in women have been found to be important adverse factors.
2. Prostate Cancer
Diverse results have been cited in the international literature about the development of prostate cancer in the presence of metabolic syndrome. Some authors reported that metabolic syndrome did not promote the development of prostate cancer.28,29 In an Australian study, it was found that increases in waist circumference, and triglyceride levels decreased the risk of development of prostate cancer.13 In a more recent study, decrease in the development of prostate cancer in the presence of overweightness or obesity and diabetes mellitus has been indicated.30
Although general opinion asserts that metabolic syndrome has an impact on the development of prostate cancer, any consensus does not exits concerning which component(s) of metabolic syndrome play(s) a role in the development of prostate cancer. Some authors have reported that none of the components of metabolic syndrome are directly associated with the development of prostate cancer. However, they have also indicated that with an increase in the number of metabolic syndrome components, risk of development of prostate cancer and its aggressiveness also increase.31
Also in a most current meta-analysis, it has been detected that metabolic syndrome is a probable risk factor for the development of prostate cancer, besides it is an important factor predicting worse prognosis. In this group of patients, metabolic syndrome is associated with worse pathologic outcomes after radical prostatectomy as Gleason score ≥8, extracapsular invasion, seminal vesicle involvement, positive surgical margin, and biochemical.32 In this study, it is determined that only one component of metabolic syndrome, namely hypertension, plays a role in the development of prostate cancer.32 In another study, evidence suggesting the role of higher TG levels (another metabolic syndrome component) in the development of prostate cancer was obtained.33 Besides, some studies have demonstrated the association between overweightness/ obesity and prostate cancer.34,35
The factors which are thought to be effective between components of metabolic syndrome and biology of prostate cancer include sex hormones, endocrine disruptors, inflammation, lipids and proteins modified by prooxidative microenvironment. Insulin and insulin-like hormones as growth factors play important roles.36,37Increases in the levels of estradiol, and sex hormone-binding globulin and sex hormone-binding globulin, and decreased free testosterone levels have been indicated to be effective on this process.38,39 Endocrine disruptors are substances which disrupts synthesis, secretions, effects, elimination of naturally existing hormones in human beings, and their binding to receptors including drugs, pesticides, plastic additives, organic contaminants. Most of them are xenoestrogens or antiandrogens.40 Changes in cytokines and leptin levels due to increased inflammation in metabolic syndrome have been shown to play a role in prostate cancer development.41
In conclusion, metabesity which is introduced as a novel concept into our use will occupy an important place in our clinical practice. Therefore components of metabolic syndrome should be considered in the practice of urological oncology.
Written by:
Ali Atan, Department of Urology, Gazi University and School of Medicine, Ankara, Turkey
Turk J Urol. 2017 Dec; 43(4): 410–413. Published online 2017 Dec 1. doi: 10.5152/tud.2017.66502
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From the Desk of the Editor: Meta-analysis of metabolic syndrome and prostate cancer
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