A trend for a 36% increased risk of a high Gleason score KPT330 in patients with MetS (OR = 1.36, 95% CI 0.90-2.06

n = 7 studies) was identified based on a meta-analysis of seven total relative databases (Figure 3). Figure 3 RR of high grade Gleason prostate cancer risk for MetS presence. Advanced clinical stage Advanced clinical stage was defined as a clinical stage ≥ T3. Four databases were included in the analysis of the association of MetS with advanced clinical stage. The analysis revealed that MetS was significantly associated with a 37% increased risk of advanced clinical stage (OR = 1.37, 95% CI: 1.12 ~ 1.68; n = 4 studies) (Figure 4). Figure 4 RR of advanced clinical stage for MetS presence. Prostate cancer progression Biochemical recurrence Only two databases [23, 27] focused on the association of MetS which biochemical recurrence. The Individual study results and the overall summary results are presented in Figure 5. The result indicates that MetS was significantly LXH254 concentration associated with 2-folds of increased risk of biochemical

recurrence (OR = 2.06, 95% CI: 1.43-2.96, n = 2 studies). Figure 5 RR of biochemical recurrence for MetS presence. Prostate selleck cancer-specific mortality Three cohort studies [14, 19, 30] investigated how MetS affected prostate cancer-specific mortality. The meta-analysis revealed that MetS was significantly associated with a higher risk of the prostate cancer-specific death (RR = 1.12, 95% CI: 1.02 ~ 1.23; n = 3 studies) (Figure 6). Figure 6 RR of prostate cancer-specific mortality for MetS presence. Sensitivity analysis We conducted sensitivity analysis by omitting one study at a time, generating the pooled estimates and comparing the pooled estimates with the original estimates. Omitting any one of nine studies concerning MetS and prostate cancer risk

or omitting any one of four studies concerning MetS and advanced clinical stage produced no dramatic influence on the original pooled RRs. Omitting Jeon 2012 database [28] in the 7 studies concerning MetS and Gleason score produced a significant OR = 1.44 (95% CI: 1.20 ~ 1.72), whereas none of the remaining severn studies exhibited a significant influence on the original estimates. For biochemical recurrence and prostate cancer-specific mortality, there were too few studies to do a sensitivity analysis. Publication bias Visual inspection Astemizole of the Begg funnel plot for both PCR and Gleason score did not reveal the asymmetry typically associated with publication bias (Figure 7). Evidence of publication bias was also not seen with the Egger or Begg tests (Egger P = 0.27 and 0.64 for prostate cancer risk and Gleason score respectively). Figure 7 Funnel plot with pseudo 95% confidence limits. Discussion In 2007, Hsing et al. summarized five studies on MetS and prostate cancer risk and concluded that the epidemiologic evidence was insufficient to suggest a link between MetS and PCa [37]. In 2012, Esposito et al.