Obesity does not predispose to more aggressive prostate cancer either at biopsy or radical prostatectomy in European men

Abstract

Many investigators suggested that obesity predisposes to adverse prostate cancer characteristics and outcomes. We tested the effect of obesity on the rate of aggressive prostate cancer at either prostate biopsy or radical prostatectomy (RP). Clinical and pathological data were available for 1,814 men. Univariable and multivariable logistic regression models addressed the rate of high grade prostate cancer (HGPCa) at either biopsy or final pathology. Clinical stage, prostate-specific antigen (PSA), percentage of free PSA and prostate volume were the base predictors. All models were fitted with and without body mass index (BMI), which quantified obesity. BMI and its reciprocal (InvBMI) were coded as cubic splines to allow nonlinear effects. Predictive accuracy (PA) was quantified with area under curve estimates, which were subjected to 200 bootstrap resamples to reduce overfit bias. Gains in PA related to the inclusion of BMI were compared using the MantelHaenszel test. HGPCa at biopsy was detected in 562 (31%) and HGPCa at RP pathology was present in 931 (51.3%) men. In either univariable or multivariable models predicting HGPCa at biopsy, BMI or InvBMI failed to respectively reach statistical significance or add to multivariable PA (BMI gain 5 0%, p 5 1.0; InvBMI gain 5 20.2%, p 5 0.9). Conversely, in models predicting HGPCa at RP, BMI and InvBMI represented independent predictors but failed to increase PA (BMI gain 5 0.7%, p 5 0.6; InvBMI gain 5 0.5, p 5 0.7%). Obesity does not predispose to more aggressive prostate cancer at biopsy. Similarly, obesity does not change the ability to identify those who may harbor HGPCa at RP. ' 2007 Wiley-Liss, Inc.

Obesity and Prostate Cancer Aggressiveness among African and Caucasian Americans in a Population-Based Study

“…Recent study results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database found that obesity is a risk factor for aggressive prostate cancer regardless of race (4). On the other hand, a cross-sectional evaluation of 1,814 prostate cancer patients in Germany suggested that obesity does not predispose to more aggressive prostate cancer either at biopsy or at radical prostatectomy (5). Similarly, a clinical cohort of 2,687 patients who underwent treatment for low and intermediate grade of prostate cancer found no association between BMI and biochemical failure after at least of 2-year follow-up (6).…”

Influence of abdominal adiposity, waist circumference, and body mass index on clinical and pathologic findings in patients treated with radiotherapy for localized prostate cancer

“…However, recent studies addressing this issue using BMI estimates indicate contradictory results. Some prostate biopsy [31][32][33][34] and prostatectomy series 19,35,36 have shown more aggressive features among obese patients, whereas no such effect was observed by other authors (Table 5).…”

“…It is interesting to note that in our patients, an association with more aggressive characteristics (GS and NCCN prostate-risk group) was observed for SAT and VAT, but not for BMI. This might explain why some previous studies, 31,33,34,36 which analyzed only the influence of BMI and not of fat distribution on adverse pathologic features, failed to find such an association ( Table 5). The results of the current study highlight the advantage of using more sophisticated anthropometric measures of abdominal adiposity than simple BMI to evaluate the influence of obesity in prostate cancer patients.…”

Relationship between BMI, PSA and Histopathological Tumor Grade in a Caucasian Population Affected by Prostate Cancer

“…Similarly, obesity does not change the ability to identify those who may harbor a high grade tumor at radical prostatectomy. In consequence, the consideration of obesity might be omitted from CaP detection or diagnostic schemes [25].…”