Introduction

Metabolic Syndrome (MetS) is widely accepted in the U.S as a critical health epidemic, as MetS has been linked to a significant increase in the risk of developing prostate cancer in recent literature, yet the number of studies analyzing this ever growing percentage of the population remains underdeveloped._x000D_ _x000D_ To assess the variation in preoperative features, operative, oncological and functional outcomes in patients who underwent RARP for a prostate cancer (PC), stratifying them by number of Metabolic Risk Factors (MRF) in a cumulative stepwise fashion.

Methods

In our IRB approved retrospective analysis, between January 2008 and March 2016, 6954 patients underwent Robot Assisted Radical Prostatectomy (RARP) for localized PC by one single surgeon (V.P) at our institution. Patients were then divided into 5 groups depending on the number of MRF(s) and obesity status: (I) 1488 non-obese (BMI <30 kg/m2) +0 MRF, (II) 439 obese + 0 MRF, (III) 671 obese + 1 MRF, (IV) 619 obesity + 2 MRFs, (V) 206 obesity + 3 MRFs. Demographic, clinical, operative, oncological and functional results were analyzed and compared. Morbidity was reported using Clavien-Dindo Classification.

Results

There were no significant differences in preoperative PSA (p>0.05). Charlson Score Index increased significantly increased from Group 1-5 while age and BMI decreased through them (p<0.001). The proportion of High Risk patients increased overall as the number of MRF(s) increased (from 12.9%, GI to 21.0% GV; p=0.003). While operative time and estimated blood loss rates increased with increasing MRF(s) (p<0.001), full nerve-sparing technique decreased through them. No differences were found in complication rate among groups (p>0.05). While adverse pathological features (tumor volume, percentage, positive surgical margins and extraprostatic extension) were found as more MRF were present (p<0.05), overall and disease specific survival were similar among them (p>0.05). Lastly, in terms of functional results; a stepwise decrease of potency and continence rates were observed through the groups (67.4 to 36.9%, and 91.9 to 80.1%, respectively), while no differences in the average time to potency and continence was observed (p>0.05).

Conclusions

In our study, despite an additive number of MRF(s) was associated with an increased risk of aggressive prostate cancer, final oncological outcomes were similar. Furthermore, an increasing number of MRF’s also was associated with a step-wise decrease recovery in functional outcomes.

Funding

None