Progressive prostate cancer (PrCA) is often treated withe androgen deprivation therapy (ADT).ADT both in the adjuvant setting as well as in advanced stages of PrCA has shown to prolong survival in prostate cancer.,The consequence of ADT is hypogonadism which is now being recognised as a risk factor for the development ofmetabolic syndrome(MS).In randomised controlled trials, patients PrCA treated with ADT has been shown to have significantly higher body mass index and lower total and free testosterone levels.The prevalence of metabolic syndrome was higher in the ADT group compared with the non-ADT group.Patients with MS have a higher incidence of sarcopaenia, abdominal obesity, hyperglycaemia, and hypertriglyceridaemia.Furthermore components of MS are known to increase the risk of cardiovascular disease and osteoporosis.Development of insulin resistance, a major constituent of the metabolic syndrome, has also been associated with the receipt of ADT.Recently the pivotal role of insulin and insulin-like growth factor-1 (IgF-1) in promoting growth of prostate cancer cells is being evaluated.Insulin is a growth factor for a number of epithelial turnouts in cell culture systems, and hyperinsulinaemia also produces a secondary increase in the availability of IGF-1.This tumour growth factor increase is also facilitated by a reduction in IGF-1 binding protein-1 levels.Due to the these factors considered potentially responsible for progression of castrate resistant prostate cancer, insulin sensitizers (ie, metformin) may mitigate some of the risks of ADT and are being studies in clinical trials to evaluate their use in reversing the development or progression of metabolic syndrome and furthermore as a potential therapeutic as an anti-tumour growth factor.ADT has clearly been shown to improve survival in advance PrCA however subjects who develop MS as a consequence of ADT have shortened life expectancy.The increased mortality may be partially caused by the cardiovascular effects of MS but MS is now also being considered itself a prognostic factor in progression of prostate cancer.Presence of the MS is reported to be associated with shorter time to castration-resistant prostate cancer (CRPC).