Metabolic syndrome in nearly 4 in 10 men after prostate cancer therapy

Clinical takeaway: Patients starting combined hormonal therapy for prostate cancer may warrant early attention to blood pressure, glucose, and lipids as part of routine treatment follow-up.

Androgen deprivation therapy is known to adversely affect metabolic health, but less is known about the frequency and timing of metabolic abnormalities among patients receiving it together with androgen receptor pathway inhibitors (ARPIs), which are increasingly used in prostate cancer treatment. A large national study found that metabolic abnormalities were frequently documented within the first year of combined therapy.

Researchers analyzed electronic health records from 16,924 men with prostate cancer who started concurrent androgen deprivation therapy and an ARPI—abiraterone, enzalutamide, apalutamide, or darolutamide—and had no documented metabolic syndrome or its components during the preceding six months.

Within 12 months, the cumulative incidence of metabolic syndrome reached 39.1%. Hypertension was the most commonly documented metabolic abnormality, with a 12-month cumulative incidence of 83.0%, followed by dyslipidemia, obesity, and insulin resistance. Metabolic syndrome was documented a median of 2.6 months after treatment initiation, underscoring how early metabolic issues may become apparent.

Age also mattered. Men aged 70 to 79 years had the highest incidence rate of metabolic syndrome and greater adjusted risks of hypertension, dyslipidemia, and insulin resistance than men younger than 70. Exploratory analyses suggested metabolic outcomes also varied among individual ARPIs, but the authors cautioned that these differences should not guide drug selection.

The study cannot determine how much of the metabolic burden was caused by adding an ARPI because there was no androgen deprivation therapy-only comparison group. Some abnormalities detected soon after treatment began may also have represented previously unrecognized disease or increased surveillance rather than truly new-onset conditions. Still, the results reinforce the importance of integrating cardiometabolic risk assessment and management into prostate cancer care.

“Metabolic outcomes varied by age and treatment context, underscoring the importance of early and systematic metabolic monitoring,” the authors concluded.

Source: Shaver AL, et al. (2026 Aug 13) JAMA Oncol. Metabolic dysfunction after initiation of androgen receptor pathway inhibitors in prostate cancer