METABOLIC SYNDROME in prostate cancer increased rapidly during the first year after men began concurrent androgen deprivation therapy (ADT) and androgen receptor pathway inhibitor (ARPI) treatment, according to a national cohort study.
Researchers conducted a retrospective cohort study using a national deidentified health record dataset to assess the development of metabolic syndrome (MetS) following treatment initiation. The analysis included 16,924 adult men with prostate cancer who had no evidence of MetS or its individual components before starting concurrent ADT and ARPI therapy.
Patients received ADT alongside abiraterone acetate, enzalutamide, apalutamide or darolutamide, with enzalutamide the most frequently used ARPI. The mean patient age was 73.1 years.
During the first 12 months following treatment initiation, the cumulative incidence of metabolic syndrome increased steadily, reaching nearly 40%.
The incidence of metabolic syndrome varied according to age, with the highest incidence observed among patients aged 70–79 years. In this group, the incidence reached 51.7 events per 1,000 person-months (95% CI: 50.7–53.9).
Hypertension was the most frequently documented metabolic abnormality during follow-up. The researchers also identified variation in metabolic outcomes according to age and ARPI type, although differences between ARPIs were examined in exploratory analyses.
The findings highlighted the extent to which metabolic dysfunction could emerge relatively soon after treatment initiation, even among patients without documented metabolic disease before starting therapy.
The authors noted that although ARPIs have become standard treatment for advanced prostate cancer, clinical monitoring may need to extend beyond cancer-specific outcomes.
The rapid emergence of metabolic abnormalities supported systematic monitoring for metabolic syndrome and its individual components during concurrent ADT and ARPI therapy. The researchers suggested that this could ideally form part of multidisciplinary care, with earlier identification of cardiometabolic risk potentially allowing appropriate interventions.
The study also highlighted the need for scalable approaches to managing metabolic health in men receiving prostate cancer treatment. Further research will be needed to evaluate interventions designed to reduce the early cardiometabolic burden associated with these therapies.
Shaver AL et al. metabolic dysfunction after initiation of androgen receptor pathway inhibitors in prostate cancer. JAMA Oncol. 2026;DOI:10.1001/jamaoncol.2026.2790.
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