Oncology The Relationship Between Prostate Cancer and Presence of Metabolic Syndrome and Late-onset Hypogonadism Mustafa Kayali, Melih Balci, Yilmaz Aslan, Ovunc Bilgin, Ozer Guzel, Altug Tuncel, and Ali Atan OBJECTIVE To investigate the relationship between prostate cancer (PCa), presence of metabolic syndrome (MetS), and late-onset hypogonadism (LOH). MATERIALS AND METHODS One hundred seventy patients who underwent transrectal ultrasonographyeguided prostate needle biopsy were included in this study. For the diagnosis of MetS, American Heart Associa- tion/National Heart, Lung, and Blood Institute criteria were used. For the diagnosis of LOH, Androgen Deficiency in Aging Males questionnaire and serum total and free testosterone levels were used. Patients were divided into 4 groups according to the presence of MetS and LOH: group 1, MetS and LOH; group 2, with MetS but without LOH; group 3, with LOH but without MetS; and group 4, with neither MetS nor LOH. RESULTS The mean age of the patients was 63.7  7.2 years. In group 1, 12 patients (37.5%); in group 2, 5 patients (25%); in group 3, 11 patients (26.8%); and in group 4, 14 patients (18.2%) were diagnosed with PCa. Aggressive PCa was determined in 7 patients in group 1 (21.9%), 2 patients in group 2 (10%), 5 patients in group 3 (12.2%), and 5 patients in group 4 (6.5%). There was a statistically significant difference only in between groups 1 and 4 in terms of detection of PCa (37.5% vs 18.2%, P ¼ .031) and aggressive PCa (21.9% vs 6.5%, P ¼ .019). CONCLUSION These results highlight the fact that coexistence of MetS and LOH increases the risk of PCa and aggressive PCa. UROLOGY -: -e-, 2014. Ó 2014 Elsevier Inc. M etabolic syndrome (MetS) is an important public health problem of the 21st century. MetS is more commonly encountered in Western lifestyle. MetS is detected in 34%-39% of the adult US population, and it is equally seen in men and women. 1 MetS includes insulin resistance, abdominal obesity, hypertension (HT), impaired glucose tolerance, and impaired lipid profile. 2 MetS has increasingly gained importance and become one of the important reasons of cardiovascular mortality and morbidity in developed countries. 3 Late-onset hypogonadism (LOH) is a clinical and biochemical syndrome occurring with decrease of androgen levels in the aging men. This condition may lead to worsening in life quality and organ and system impairement. 4 Although the incidence is not clearly known, Massachusetts Male Aging Study reported an annual incidence of 12/1000. 5 Some authors have reported that hypogonadism should be accepted as a classic component of MetS. 6,7 Prostate cancer (PCa) is the second cause of cancer- related deaths in men. 8 Although MetS plays a role in PCa etiology, the data are limited. Limited number of studies concerning MetS and PCa correlation are present, and the results are not clear. However, there are studies saying otherwise 9 ; some studies report higher PCa risk rates in low serum testosterone levels, thus these cancers have an aggressive nature. 10-12 We aimed to research the correlation between MetS and LOH with PCa and the incidence of aggressive PCa in these patients. MATERIALS AND METHODS Our study prospectively included 170 male patients presenting to our clinic between May 2009 and September 2013 with lower urinary system symptoms. All patients had undergone a standard 10-core transrectal ultrasonographyeguided prostate biopsy performed by the same author (M.K.) because of high prostate- specific antigen (PSA) levels and/or abnormal rectal examina- tion. All pathologic investigations were performed by 2 skilled uropathologists in our center. Informed consent was obtained from all patients. Medical conditions such as diabetes mellitus (DM), HT, dyslipidemia, coronary artery disease, use of medi- cation, and past surgeries were recorded. Patients having ma- lignancy other than PCa, severe liver and kidney dysfunction, and those receiving hormone treatment or 5-alpha-reductase inhibitors were excluded from the study. From the Third Department of Urology, Ankara Numune Research and Training Hospital, Ministry of Health, Ankara, Turkey; and the Department of Urology, Gazi University, School of Medicine, Ankara, Turkey Reprint requests: Altug Tuncel, M.D., Third Department of Urology, Ankara Numune Research and Training Hospital, Ministry of Health, 06120 Sihhiye, Ankara, Turkey. E-mail: tuncelaltug@yahoo.com Submitted: April 21, 2014, accepted (with revisions): July 5, 2014 ª 2014 Elsevier Inc. All Rights Reserved http://dx.doi.org/10.1016/j.urology.2014.07.015 0090-4295/14 1