CONCLUSIONS
metabolic syndrome, cardiovascular death
METABOLIC SYNDROME, DISEASE
The present study has numerous strengths including the longitudinal, prospective and placebo-controlled design. The main limitation in assessing the effect of empiric metformin in this study is the limited sample size and variance in criteria to determine metabolic syndrome. Outside of our study, there is evidence to suggest that ADT increases the risk of metabolic syndrome that led to cardiovascular death with prolonged use. For men with PC requiring ADT, many of whom required lifelong ADT, efforts to reduce metabolic syndrome through lifestyle modification including diet and exercise may mitigate some of the risks of ADT. Numerous studies of metformin have been completed in a variety of disease states and settings and future metanalyses may help determine metformin’s true benefit in PC. We anticipate that future larger interventional studies assessing both therapeutic modulation and lifestyle changes will determine whether survival of men with PC requiring ADT can ultimately be improved by this approach.