Body Mass Index, Weight Change, and Risk of Prostate Cancer in the Cancer Prevention Study II Nutrition Cohort (original) (raw)
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Obesity as a risk factor for prostate cancer: A clinical review
Integrative Cancer Science and Therapeutics, 2016
Epidemiological studies have shown a significant association between obesity and several cancers, but the role of obesity in prostate cancer etiology remains elusive. More recent studies somewhat clarify this complex relationship and we sought to review the data linking obesity and prostate cancer to make sense of this conflicting data. To systematically evaluate epidemiologic data available we performed a Google Scholar search with the following keywords: "obesity", "prostate cancer", "obesity and prostate cancer." Recent prospective studies suggest obesity is associated with increased risk of aggressive prostate cancers but with a reduced risk of low-grade tumors. The etiology of the differential effect of obesity on subtypes of prostate cancer is multifactorial, and interactions between hormonal changes including sex steroids, insulin, IGF's and inflammatory mediators have been implicated. It has also been suggested that it is harder to detect prostate cancer in obese men through routine diagnostic approaches. Given the high prevalence of obesity and prostate cancer in the western world, further research to evaluate this complex relationship is warranted. Furthermore, novel approaches may be required to improve disease prostate cancer diagnosis among obese individuals.
Obesity increases the risk for high-grade prostate cancer: results from the REDUCE study
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2014
Studies suggest that obesity is associated with lower risk of prostate cancer but more aggressive cancers. As obesity lowers PSA levels, these observations may be influenced by detection bias. We examined the association between obesity and risk of low- and high-grade prostate cancer in REDUCE, in which biopsies were largely independent of PSA. The REDUCE study tested dutasteride for prostate cancer risk reduction in men with a PSA of 2.5 to 10.0 ng/mL and a negative biopsy. Study participants included 6,729 men who underwent at least one on-study biopsy. The association between baseline body mass index (BMI <25 kg/m(2) normal weight; 25-29.9 kg/m(2) overweight; and ≥30 kg/m(2) obese) and risk of high-grade (Gleason ≥7) or low-grade prostate cancer (Gleason <7) versus no prostate cancer was examined using multinomial logistic regression. Overall, 1,739 men (27%) were normal weight, 3,384 (53%) overweight, and 1,304 (20%) were obese. Obesity was associated with lower risk of lo...
Cancer, 2007
BACKGROUND. Adiposity has been linked inconsistently with prostate cancer, and few studies have evaluated whether such associations vary by disease aggressiveness. METHODS. The authors prospectively examined body mass index (BMI) and adult weight change in relation to prostate cancer incidence and mortality in 287,760 men ages 50 years to 71 years at enrollment (1995-1996) in the National Institutes of Health-AARP Diet and Health Study. At baseline, participants completed questionnaires regarding height, weight, and cancer screening practices, including digital rectal examinations and prostate-specific antigen tests. Cox regression analysis was used to calculate relative risks (RR) and 95% confidence intervals (95% CIs). RESULTS. In total, 9986 incident prostate cancers were identified during 5 years of follow-up, and 173 prostate cancer deaths were ascertained during 6 years of followup. In multivariate models, higher baseline BMI was associated with significantly reduced total prostate cancer incidence, largely because of the relationship with localized tumors (for men in the highest BMI category [!40 kg/m 2 ] vs men in the lowest BMI category [<25 kg/m 2 ]: RR, 0.67; 95% CI, 0.50-0.89; P ¼ .0006). Conversely, a significant elevation in prostate cancer mortality was observed at higher BMI levels (BMI <25 kg/m 2 : RR, 1.0 [referent group]; BMI 25-29.9 kg/m 2 : RR, 1.25; 95% CI, 0.87-1.80; BMI 30-34.9 kg/m 2 : RR, 1.46; 95% CI, 0.92-2.33; and BMI !35 kg/m 2 : RR, 2.12; 95% CI, 1.08-4.15; P ¼ .02). Adult weight gain from age 18 years to baseline also was associated positively with fatal prostate cancer (P ¼ .009), but not with incident disease. CONCLUSIONS. Although adiposity was not related positively to prostate cancer incidence, higher BMI and adult weight gain increased the risk of dying from prostate cancer.
Weight change and prostate cancer incidence and mortality
International Journal of Cancer, 2012
The relationship between obesity and prostate cancer risk has been studied extensively but with inconsistent findings, particularly for tumor aggressiveness. Few studies have investigated weight change and prostate cancer incidence or mortality. Using the Melbourne Collaborative Cohort Study, which recruited 17,045 men aged between 40 and 69 years at study entry, we investigated associations between reported weight and body mass index (BMI) at age 18 and measured at study entry, height, weight change between age 18 and study entry and prostate cancer incidence and mortality. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. During follow-up (mean 5 15 years) of 16,514 men, we ascertained 1,374 incident prostate cancers of which 410 were classified as aggressive, and 139 deaths from prostate cancer. The incidence of all prostate cancer was not associated with body size or weight change. Weight and BMI at study entry were positively associated with aggressive prostate cancer risk (HR 5 1.06, 95% CI: 1.00-1.13 per 5 kg; HR 5 1.27, 95% CI: 1.08-1.49 per 5 kg/m 2 ) and prostate cancer mortality (HR 5 1.12, 95% CI: 1.01-1.23 per 5 kg; HR 5 1.49, 95% CI: 1.11-2.00 per 5 kg/m 2 ). Weight gain was positively associated with prostate cancer mortality (HR 5 1.13, 95% CI: 1.02-1.26 per 5 kg increment); the HR for 20 kg weight gain between age 18 and study entry compared to <5 kg gain over this period was 1.84, 95% CI: 1.09-3.09. Higher adult weight and BMI increases the risk of aggressive prostate cancer and mortality from prostate cancer. Weight gain during adult life is associated with increased prostate cancer mortality.
International Journal of Cancer, 2007
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 Mantel-Haenszel 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.
BACKGROUND: Obesity has been inconsistently linked to prostate cancer, mainly with mortality rather than incidence. Few large-scale studies exist assessing obesity in relation to prostate-specific antigen (PSA)-detected prostate cancer. METHODS: We used cases and stratum-matched controls from the population-based PSA-testing phase of the Prostate testing for cancer and Treatment study to examine the hypothesis that obesity as measured by body mass index (BMI), waist circumference and waist-to-hip ratio (WHR) is associated with increased prostate cancer risk, and with higher tumour stage and grade. In all, 2167 eligible cases and 11 638 randomly selected eligible controls with PSA values were recruited between 2001 and 2008. A maximum of 960 cases and 4156 controls had measurement data, and also complete data on age and family history, and were included in the final analysis. BMI was categorised as o25.0, 25.0 -29.9, X30.0 in kg m À2 . RESULTS: Following adjustment for age and family history of prostate cancer, we found little evidence that BMI was associated with total prostate cancer (odds ratio (OR): 0.83, 95% confidence interval (CI): 0.67, 1.03; highest vs lowest tertile; P-trend 0.1). A weak inverse association was evident for low-grade (OR: 0.76, 95% CI: 0.59, 0.97; highest vs lowest tertile; P-trend 0.045) prostate cancer. We found no association of either waist circumference (OR: 0.94, 95% CI: 0.80, 1.12; highest vs lowest tertile) or waist-to-hip ratio (WHR; OR: 0.93, 95% CI: 0.77, 1.11; highest vs lowest tertile) with total prostate cancer, and in analyses stratified by disease stage (all P-trend40.35) or grade (all P-trend40.16). CONCLUSION: General adiposity, as measured by BMI, was associated with a decreased risk of low-grade PSA-detected prostate cancer. However, effects were small and the confidence intervals had limits very close to one. Abdominal obesity (as measured by WHR/waist circumference) was not associated with PSA-detected prostate cancer.
British journal of cancer, 2011
Obesity has been inconsistently linked to prostate cancer, mainly with mortality rather than incidence. Few large-scale studies exist assessing obesity in relation to prostate-specific antigen (PSA)-detected prostate cancer. We used cases and stratum-matched controls from the population-based PSA-testing phase of the Prostate testing for cancer and Treatment study to examine the hypothesis that obesity as measured by body mass index (BMI), waist circumference and waist-to-hip ratio (WHR) is associated with increased prostate cancer risk, and with higher tumour stage and grade. In all, 2167 eligible cases and 11 638 randomly selected eligible controls with PSA values were recruited between 2001 and 2008. A maximum of 960 cases and 4156 controls had measurement data, and also complete data on age and family history, and were included in the final analysis. BMI was categorised as <25.0, 25.0-29.9, ≥ 30.0 in kg m(-2). Following adjustment for age and family history of prostate cancer...
Obesity before Age 30 Years and Risk of Advanced Prostate Cancer
American Journal of Epidemiology, 2005
Adult obesity has shown little association with prostate cancer risk, but obesity at younger ages may be associated with reduced risk. In 1997-2000, the relation between obesity before age 30 years and incident advanced prostate cancer was investigated in a population-based case-control study of African-American and White men (568 cases, 544 controls) in California. Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals, adjusted for age, race, family history of prostate cancer, and saturated fat intake. Measures of obesity for age 10 years tended to be inversely associated with prostate cancer (odds ratio (OR) ¼ 0.79, 95% confidence interval (CI): 0.46, 1.38 for selecting the ''obese'' pictogram and OR ¼ 0.76, 95% CI: 0.52, 1.11 for reporting being heavier than peers). The decreased risk was more pronounced at ages 20-29 years (OR ¼ 0.53, 95% CI: 0.28, 1.00 for the ''obese'' drawing, OR ¼ 0.59, 95% CI: 0.40, 0.88 for being heavier than peers, and OR ¼ 0.40, 95% CI: 0.20, 0.81 for body mass index 30 kg/m 2 ). In addition, both ''obese'' and small waist size at ages 20-29 years showed inverse trends. This research implicating early-life body size in prostate cancer development helps to elucidate causal mechanisms, such as altered sex hormone profiles during critical developmental periods, potentially involved in development of the disease. age factors; body mass index; body size; case-control studies; child; obesity; prostatic neoplasms; risk factors Abbreviations: BMI, body mass index; CI, confidence interval; OR, odds ratio.
Association of body mass index and prostate cancer mortality
Obesity Research & Clinical Practice, 2014
Objectives-Inconsistent evidence exists on whether obesity is associated with an increased risk of prostate cancer death post-radical prostatectomy. We examined data from three large health plans to evaluate if an increased body mass index (BMI) at prostate cancer diagnosis is related to prostate cancer mortality. Subjects & Methods-This population-based case-control study included 751 men with prostate cancer who underwent radical prostatectomy. Cases were men who died due to prostate cancer (N=323) and matched controls (N=428). We used multivariable logistic regression models to assess the association between BMI at diagnosis and prostate cancer mortality, adjusted for Gleason score, PSA, tumor characteristics, and matching factors. Results-Study subjects were classified into the following BMI (kg/m 2) categories: healthy (18.5-24.9), overweight (25-29.9) and obese (≥ 30). Nearly 43% of the participants had a BMI ≥25 at diagnosis. A higher fraction of cases (30%) were obese compared to controls (22%). Overall, obese men had more than a 50% increase in prostate cancer mortality (adjusted odds ratio=1.50 [95% CI, 1.03-2.19]) when compared to men with healthy BMI. After stratifying by Gleason score, the odds of mortality generally rose with increasing BMI. The strongest effect was observed in the Gleason Score 8+ category (2.37, 95% CI: 1.11-5.09). These associations persisted after adjusting for PSA at diagnosis and other tumor characteristics. Conclusions-These results suggest that BMI at diagnosis is strongly correlated with prostate cancer mortality, and that men with aggressive disease have a markedly greater odds of death if they are overweight or obese.