['To evaluate the association between metabolic syndrome (MS) and prostate cancer diagnosis and grade in patients undergoing prostate biopsy.', 'From 2009 onwards, a consecutive series of patients undergoing 12-core prostate biopsy for PSA value ≥4\u2009ng/ml and/or positive digital rectal examination (DRE) were prospectively enrolled. Body mass index (BMI), waist circumferences, and blood pressure were measured before the biopsy. Blood samples were tested for: PSA, fasting glucose, triglycerides, and cholesterol HDL. MS presence was defined according to Adult Treatment Panel III criteria.', 'One hundred ninety five patients were enrolled with a median age and PSA of 69 years and 5.6\u2009ng/ml respectively. Median BMI was 27.6\u2009kg/m(2) with 64 patients (33%) being classified as obese (BMI\u2009≥\u200930\u2009kg/m(2) ). Eighty-six patients (44%) had MS. Eighty-three patients (43%) had cancer on biopsy; 37 (45%) with MS and 46 (55%) without (P\u2009=\u20090.48). PSA was independently associated with higher risk of cancer (OR 1.12/1\u2009U PSA, P\u2009=\u20090.01). Out of 83 patients with prostate cancer, 42 (51%) had Gleason score 6 (12 (28.5%) presented a MS) and 41 (49%) a Gleason score ≥7 (25 (61%) presented a MS). The presence of MS was not associated with an increased risk prostate cancer (OR: 0.97, P\u2009=\u20090.94) but with an increased risk of Gleason ≥7 (OR: 3.82; P\u2009=\u20090.013).'] Is metabolic syndrome associated with high grade Gleason score when prostate cancer is diagnosed on biopsy?