Glucose impairments and insulin resistance in prostate cancer: the role of obesity, nutrition and exercise

• Published in: Obesity reviews 2018-07, Vol.19 (7), p.1008-1016
• Main Authors: Di Sebastiano, K. M., Pinthus, J. H., Duivenvoorden, W. C. M., Mourtzakis, M.
• Format: Article
• Language: English
• Subjects: Adipose tissue; Body composition; Cancer; Cardiovascular diseases; C‐peptide; Deprivation; Diabetes; Diabetes mellitus; Exercise; Glucose; Glucose metabolism; Health risks; Humans; Hyperinsulinemia; Insulin; Insulin Resistance; insulin‐like growth factor; Male; Metabolic syndrome; Metabolic Syndrome - blood; Metabolic Syndrome - metabolism; Metabolism; Nutrition; Nutritional Status; Obesity; Obesity - blood; Obesity - metabolism; Patients; Prostate cancer; Prostatic Neoplasms - blood; Prostatic Neoplasms - metabolism; Prostatic Neoplasms - physiopathology; Risk Factors; Survival
• ISSN: 1467-7881; 1467-789X
• DOI: 10.1111/obr.12674

Summary Background Hyperinsulinemia, obesity and related metabolic diseases are associated with prostate cancer development. Prostate cancer patients undergoing androgen deprivation therapy (ADT) are at increased risk for metabolic syndrome, cardiovascular disease and diabetes, while pre‐existing metabolic conditions may be exacerbated. Purpose An integrative approach is used to describe the interactions between insulin, glucose metabolism, obesity and prostate cancer. The potential role of nutrition and exercise will also be examined. Findings Hyperinsulinemia is associated with prostate cancer development, progression and aggressiveness. Prostate cancer patients who undergo ADT are at risk of diabetes in survivorship. It is unclear whether this is a direct result of treatment or related to pre‐existing metabolic features (e.g. hyperinsulinemia and obesity). Obesity and metabolic syndrome are also associated with prostate cancer development and poorer outcomes for cancer survivors, which may be driven by hyperinsulinemia, pro‐inflammation, hyperleptinemia and/or hypoadiponectinemia. Conclusions Independently evaluating changes in glucose metabolism near the time of prostate cancer diagnosis and during long‐term ADT treatment is important to distinguish their unique contributions to the development of metabolic disturbances. Integrative approaches, including metabolic, clinical and body composition measures, are needed to understand the role of adiposity and insulin resistance in prostate cancer and to develop effective nutrition and exercise interventions to improve secondary diseases in survivorship.