Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance

Background: Metabolic syndrome (MetS) is considered a potential risk factor for adverse outcomes after radical prostatectomy (RP). Furthermore, studies about the effect of MetS on low-risk prostate cancer (PCa) and its implications in active surveillance (AS) are limited. Objective: To investigate the role of MetS (using International Diabetes Federation–American Heart Association/National Heart, Lung, and Blood Institute criteria) on perioperative and oncological outcomes after RP in low-risk PCa and in a subgroup potentially eligible for AS. Design, setting, and participants: A total of 3662 patients treated with RP for low-risk PCa and further stratified as very low risk (VLR) PCa—prostate-specific antigen density of ≤0.15 ng/ml/cm³, ≤2 cores involved, and no core with >50% cancer involvement—at a tertiary referral hospital were identified. Outcome measurements and statistical analysis: Outcomes analyzed were pathological outcomes, perioperative complications, biochemical failure (BCF), and overall survival. Pathological outcomes and complications were analyzed with logistic regression models. Kaplan–Meier curves and Cox proportional hazards models were used to analyze survival outcomes. Results and limitations: In univariate/multivariate analyses, MetS was associated with upgrading and positive surgical margins in the entire cohort, upgrading only in the VLR group. In Kaplan–Meier analysis, MetS patients had a higher rate of overall death (p < 0.0001) and BCF (p = 0.03) for MetS patients. In the VLR group, no differences were found for BCF (p = 0.064). Further, in Cox proportional hazards models, MetS was not associated with BCF (hazard ratio = 1.23; 95% confidence interval [CI] = 0.95–1.60, p = 0.12). MetS patients had a higher rate of complications compared with non-MetS patients (23.7% vs 19.7%; p = 0.01). In multivariate analysis, MetS was associated with a higher rate of complications (odds ratio = 1.24, 95% CI = 1.04–1.49, p = 0.018) but did not impact the rate of major ones. This study is limited by its retrospective design. Conclusions: In low-risk PCa treated with RP but potentially eligible for AS, MetS impacted perioperative and pathological outcomes, suggesting further study of MetS in patients undergoing AS. Patient summary: Metabolic syndrome negatively impacts perioperative and pathological outcomes in low-risk prostate cancer patients treated with radical prostatectomy but potentially eligible for active surveillance, in a large American single-center cohort. These findings suggest the need for a more cautious approach to low-risk prostate cancer in patients with metabolic syndrome. Metabolic syndrome impacts the risk of outcomes in a cohort of low-risk prostate cancer treated with radical prostatectomy but potentially eligible for active surveillance, suggesting the need of a careful approach to low-risk prostate cancer in patients with metabolic syndrome.