Is There a Role for Body Mass Index in the Assessment of Prostate Cancer Risk on Biopsy?

Abstract

Purpose To examine the role of body mass index (BMI) in assessment of prostate cancer (PCa) risk. Materials and Methods 3,258 participants who underwent biopsy (including 1,902 men with a diagnosis of PCa) were identified from the Selenium and Vitamin E Cancer Prevention Trial. The associations of BMI with PCa and high-grade PCa (HGPCa) were examined using logistic regression, adjusting for age, race, BMI-adjusted prostate-specific antigen, digital rectal exam, family history of PCa, previous biopsy history, PSA velocity and time between study entry and the last biopsy. The prediction models were compared with our previously-developed BMI-adjusted Prostate Cancer Prevention Trial prostate cancer Risk Calculator (bmiPCPTRC). Results Of the study subjects, 49.1% were overweight and 29.3% were obese. After adjustment, among men without a known family history of PCa, increased BMI was not associated with higher risk of PCa (per one-unit increase in logBMI: OR=0.83, p=0.54) but was significantly associated with higher risk of HGPCa (i.e., Gleason score≥7 prostate cancer) (OR=2.31, p=0.03). For men with a known family history of PCa, the risks of PCa and HGPCa increased rapidly as BMI increased (PCa: OR=3.73, p=0.02; HGPCa: OR=7.95, p=0.002). The bmiPCPTRC generally underestimated the risks of PCa and HGPCa. Conclusions BMI provided independently predictive information regarding risks of PCa and HGPCa, after adjusting for other risk factors. BMI, especially among men with a known family history of PCa, should be considered for inclusion in any clinical assessment of PCa risk and recommendations regarding prostate biopsy.

Waist circumference, waist-hip ratio, body mass index, and prostate cancer risk: Results from the North-American case-control study Prostate Cancer & Environment Study

“…Similar results were also found in a prospective cohort study [8]. The same study showed results in the opposite direction when obesity and high-grade PCa were examined, similar to those of other authors [9]. Conversely, a European prospective cohort study showed no association between elevated BMI and risk of PCa, regardless of grade [10].…”

Association Between the Body Mass Index and Prostate Cancer at Biopsy is Modified by Genetic Risk

“… 15 – 17 Liang et al found that BMI was significantly associated with higher PCa risk only in those with a known family history. 10 Another study reported a notably positive association between visceral obesity and aggressive PCa risk, mainly among Black men, but not non-Black men. 18 Hence, the influence of obesity on PCa carcinogenesis may differ according to different genetic backgrounds.…”

“… 3 , 13 However, inconsistent conclusions among individual studies showed different effects of obesity on different cancer subtypes and tumors of different genetic origins. 10 , 14 For example, lower levels of free testosterone were observed in obese men, which in turn was associated with decreased risk of localized/nonaggressive PCa and increased risk of advanced/aggressive PCa. 15 – 17 Liang et al found that BMI was significantly associated with higher PCa risk only in those with a known family history.…”

“…This hypothesis was suggested by a recent report which indicated that obesity, as evaluated by the body mass index (BMI), was an independent predictor of PCa only in patients with positive family history. 10 To our knowledge, no study to date has investigated whether the association between BMI and PCa risk differs according to different genetic susceptibilities. Therefore, in this study, we examined the interaction of GRS with obesity on PCa risk at biopsy, aiming to identify the population that would benefit most from GRS.…”

Clinical and biochemical markers of visceral adipose tissue activity: Body mass index, visceral adiposity index, leptin, adiponectin, and matrix metalloproteinase-3. Correlation with Gleason patterns 4 and 5 at prostate biopsy

“…Liang et al . [ 34 ] recently reported a correlation between BMI and diagnosis of high-risk prostate cancer at biopsy on 1902 men identified from the Selenium and Vitamin E Cancer Prevention Trial, especially among men without a known family history of prostate cancer.…”