Metabolic Syndrome & Survival

[pca2004]

New study from China below [1].

Note: "MetS" =  Metabolic Syndrome; "mPCA" = metastatic PCa.

"190 patients diagnosed with mPCA by pathology and imaging from January 2010 to August 2021 ... including 111 cases in the MetS group and 79 cases in the Non-MetS group."

"Those with mPCA combined with MetS had ... more aggressive tumors, shorter time to progression to CRPC and shorter median survival times than those with mPCA without MetS."

Note: "Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL)."  [2]

IMO, "abdominal obesity" is a surrogate for visceral fat.

I would replace "high blood sugar" with insulin resistance.  {The triglycerides:HDL-C ratio is a surrogate for insulin resistance.}

ADT worsens MetS symptoms.

IMO, there is a strong case for Metformin while on ADT.

New study from Spain [3]. 

"Men with obesity tend to be insulin resistant and often have low-normal testosterone concentrations."

"We did a 1-year, parallel, randomized, double-blind, placebo-controlled trial, where we evaluated the independent and combined effects of metformin and testosterone in 106 men with obesity"

"the {insulin resistance} index decreased significantly in all active groups compared to placebo"

"No significant changes in body composition (except for a higher decrease in fat mass in the metformin and combination group)"

Old mouse study from the Netherlands [4]: 

"Metformin lowers plasma triglycerides"

-Patrick

[1]  pubmed.ncbi.nlm.nih.gov/365...

[2]  en.wikipedia.org/wiki/Metab...

[3]  pubmed.ncbi.nlm.nih.gov/359...

[4]  pubmed.ncbi.nlm.nih.gov/242...

[GreenStreet]

Thanks for posting. I am sure you are on to something re metabolic syndrome. I need to recheck my latest numbers. Greetings of the season to you. Best wishes

[NPfisherman]

Forget about PCa and obesity... Obesity is one of the leading causes for health deterioration and death. More good information. People have to change eating habits and lifestyle. Okay,back to the gym...Christmas is over.Thanks for posting.

Fish

[MateoBeach]

It’s good to see RCT data on metformin in non-diabetic men, as per the Spanish trial (3). Showing decreased insulin resistance as well as greater loss of body fat. Supports my use of 1000 mg Metformin per day. Body fat per calipers now down below 12%. The intermittent high testosterone per my mBAT protocol no doubt helps, as would IADT. But good to see the Metformin benefits in non diabetics even without raising testosterone.

Just being on ADT is probably enough to put one in equivalent of metabolic syndrome with attendant risks so should be assessed and considered. I like the HOMA-IR measure they used for insulin resistance, rather than just fasting glucose. It only requires asking to have an insulin level added to your standard blood panel with fasting glucose. The HOMA- Insulin Resistance Index is the ratio of Glucose to Insulin in international units. Many calculators online make this simple. Ideal is close to 1.0. 2.0 or higher is significant resistance. Paul

mdcalc.com/calc/3120/homa-i...