Association of body mass index and prostate cancer mortality (original) (raw)
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Associations between Body Mass Index and Prostate Cancer: The Impact on Progression-Free Survival
Medicina
Background and objectives: This study aimed to evaluate the impact of body mass index on PCa outcomes in our institution and also to find if there are statistically significant differences between the variables. Materials and Methods: A retrospective chart review was performed to extract information about all male patients with prostate cancer between 1 February 2015, and 25 October 2022, and with information about age, weight, height, follow-up, and PSA. We identified a group of 728 patients, of which a total of 219 patients resulted after the inclusion and exclusion criteria were applied. The primary endpoint was progression-free survival, which was defined as the length of time that the patient lives with the disease, but no relapses occur, and this group included 105 patients. In this case, 114 patients had a biological, local or metastatic relapse and were included in the progression group. Results: Our study suggests that prostate cancer incidence rises with age (72 ± 7.81 yea...
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.
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.
Obese men have higher-grade and larger tumors: an analysis of the duke prostate center database
Prostate Cancer and Prostatic Diseases, 2009
Obesity is associated with increased risk of positive surgical margins and prostate specific antigen (PSA) recurrence among men undergoing radical prostatectomy. To what degree positive margins contribute to poorer outcome is unclear. Thus, we sought to examine the association between body mass index (BMI) and more objective measures of tumor aggressiveness, tumor grade and size. We carried out a retrospective analysis of 2302 patients treated with radical prostatectomy at the Duke Prostate Center from 1988-2007. Tumor volume was calculated by multiplying prostate weight by percent of specimen involved with cancer. Associations between BMI and tumor volume and highgrade disease (GleasonX4 þ 3) independent of pre-operative clinical characteristics of age, race, PSA, clinical stage, biopsy Gleason sum, and year of surgery were assessed using linear and logistic regression, respectively. Mean and median BMI among all subjects was 28.1 and 27.6 kg m -2 , respectively. Increased BMI was significantly associated with younger age (Po0.001), black race (Po0.001), more recent year of surgery (Po0.001), and positive surgical margins (Po0.001). After adjusting for multiple clinical pre-operative characteristics, higher BMI was associated with a greater percent of the prostate involved with cancer (P ¼ 0.003), increased tumor volume (Po0.001), and high-grade disease (P ¼ 0.007). Men with a BMI X35 kg m 2 had nearly 40% larger mean tumor volumes than normal weight men (5.1 versus 3.7 cc), after adjustment for multiple clinical characteristics. In this study, obese men undergoing radical prostatectomy had higher-grade and larger tumors, providing further evidence that obese men undergoing radical prostatectomy have more aggressive prostate cancers.
Body mass index and the risk of prostate cancer
Open Access Medical Statistics, 2012
Background: This article presents cohort studies that use data from the National Health Information Survey from 1986 to 1994 and compares the effectiveness of Cox proportional hazards models that assume a linear relationship between body mass index (BMI) and the risk of prostate cancer with models that assume a J-shaped relationship. Methods and results: Our study found that for black males over 40 years of age, neither a linear nor a J-shaped relationship yielded a statistically significant model. With white males over 40 years, assuming a linear relationship did not yield a statistically significant model (P = 0.582). When we assume a J-shaped relationship, the optimal change point where the risk of prostate cancer death is minimized occurs when the BMI is 25.5. Among white males over 40 years with BMI , 25.5, an inverse relationship was found (P = 0.009). Among white males over 40 years with BMI. 25.5, a direct relationship was found (P = 0.017). Conclusion: With this data set, we found that for white males over 40 years, Cox proportional hazards models that assume a J-shaped relationship between BMI and prostate cancer death provide a much better fit than models assuming a linear relationship.
Body Mass Index Trends and Role of Obesity in Predicting Outcome After Radical Prostatectomy
Urology, 2008
One in three American men is obese (body mass index [BMI] Ն30 kg/m 2); however, the relationship between obesity and prostate cancer is highly debated. We examined BMI trends in patients undergoing radical prostatectomy (RP) and evaluated the role of obesity in predicting biochemical failure (BCF) after RP. METHODS From 1988 to 2006, 964 patients underwent RP and had BMI data available. The patients who had received neoadjuvant therapy or were followed up for Ͻ1 year were excluded, yielding 702 patients who were grouped by BMI and stratified by year of surgery. The postoperative Kattan nomogram was used to assess BCF risk after RP. Obese and nonobese patients' BCF rates were compared using the Kaplan-Meier method, and Cox proportional hazard models were used to assess the effect of obesity on BCF. RESULTS The mean BMI (P ϭ .02) and proportion of patients undergoing RP who are obese (P ϭ .02) have increased, parallel to, but less than, national trends. Our obese patients had higher grade cancer and showed a trend toward having a more advanced pathologic stage. Obese patients also had a lower predicted free from BCF survival at 7 years (74.3% vs 80.1%). However, no difference was found in the obese and nonobese patients' actual observed BCF rates (P ϭ .48), nor was obesity an independent predictor of BCF in univariate or multivariate models (P ϭ .46). CONCLUSIONS The growing proportion of obesity at RP parallels, but is less than, national trends. Our data have shown that, despite the increased recurrence risk and advanced tumor parameters, obesity does not contribute to predicting BCF for a given tumor stage, grade, or prostate-specific antigen level on multivariate analysis.
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...
BJU International, 2009
evaluated the histopathological features and the clinical follow-up after RP. The median (range) age of the men was 64.4 (41.1-80.1) years and the median follow-up 5.5 (0.1-15.1) years. The preoperative median prostate-specific antigen (PSA) levels for normal, overweight and obese patients were 9.0 (0.3-133.0), 8.9 (0.4-230.0) and 9.2 (0.5-194.0) ng/mL, respectively. RESULTS Serum PSA levels were no different among the three groups (P = 0.92). The normal, overweight and obese patients had organconfined prostate cancer in 53.7%, 57.1% and 58.6%, respectively (P = 0.34) and had lymph node metastases in 7.9%, 7.6% and 4.6% (P = 0.58). Tumour grading was no different for the three groups (P = 0.25). The PSA recurrence-free, prostate cancerspecific and overall survival for the three BMI groups did not differ significantly (each P > 0.05). CONCLUSION The BMI cannot be shown to be a predictor of adverse prognosis either for histopathological features or for the clinical outcome, e.g. PSA-free, prostate cancerspecific and overall survival, in a mid-European study population after RP. KEYWORDS prostate cancer, body mass index, PSA, radical prostatectomy Study Type-Prognosis (case series) Level of Evidence 4 OBJECTIVES To evaluate the effect of body mass index (BMI) on the histopathological and clinical outcome in prostate cancer. PATIENTS AND METHODS In a prospective urological cancer database, 620 patients with prostate cancer had a radical prostatectomy (RP) as a curative treatment. The patients were categorized into three groups of BMI (kg/m 2); ≤ 25.0 (190, 'normal weight'), > 25.0-30.0 (343, 'overweight') and > 30.0 (87, 'obese'). We