Third, the pathological stage data in some studies were from biopsy not radical prostatectomy specimens. Last but not least, to date there remains limited studies focusing on this association, although many of the available studies are well designed case-control or longitudinal cohort studies. In addition to the limitations listed above, another limitation for the analyses of the association between MetS and prostate cancer risk or prostate cancer parameters is that we did not perform a meta-regression to attempt to explain the heterogeneity

of the study because Cell Cycle inhibitor of the varying adjustments in the individual studies. The result of a recent meta-analysis on 9 cross-sectional studies of metabolic syndrome in adult cancer survivors increases the weight of this suspicion, as it revealed that no significant association was found for non-hematologic malignancies, including testicular tumor, prostate cancer, sarcoma, and epithelial ovarian [45]. Therefore, there is an urgent future need to confirm this association and to find potential mechanisms to explain how metabolic factors affect the development or progression of Lorlatinib PCa. Conclusions Based on the current findings,

MetS is not associated with prostate cancer risk, but preliminary evidences demonstrates that men with MetS more frequently suffer high-grade prostate cancer, more advanced disease and are at greater risk of progression after radical prostatectomy and prostate cancer-specific death. Together, these findings indicate

that MetS may be associated with the progression of prostate cancer and adverse clinical outcomes. Tolmetin Further studies with adjustment for appropriate confounders and larger, prospective, multicenter investigations are required in the future. Acknowledgments The authors thank Dina A Yousif from department of Medcine, Vanderbilt University, USA for checking the English language of the manuscript. Funding This study was supported by China Scholarship Council (NO: 2009622110) and National Science Fund for Distinguished Young Scholars (NO: 81202016). References 1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin 2011,61(2):69–90.PubMedCrossRef 2. Siegel R, Ward E, Brawley O, Jemal A: Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011,61(4):212–236.PubMedCrossRef 3. Nelson WG, De Marzo AM, Isaacs WB: Prostate cancer. N Engl J Med 2003,349(4):366–381.PubMedCrossRef 4. Reaven GM: Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988,37(12):1595–1607.PubMedCrossRef 5.