IGF1 and Hyperinsulinemia: In addition, the presence of MetS was supposed to be closely associated with increased incidence, aggressiveness and unfavorable prognosis of PCa as well, while several potential molecular mechanisms and metabolic pathways are well characterized including insulin resistance and comorbid hyperinsulinemia [dysregulation of the insulin-like growth factor (IGF) signaling pathway] [28], pro-inflammatory condition and abnormal adipokines levels [16, 29], and a microenvironment conducive to tumor formation induced by adipose tissue [30, 31].