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Obesity and biochemical outcome following radical prostatectomy for organ confined disease with negative surgical margins.
J Urol 2004; 172(2):520-4JU

Abstract

PURPOSE

We have previously shown that men with a body mass index (BMI) greater than 35 kg/m2 had higher rates of positive surgical margins and significantly higher biochemical recurrence rates following radical prostatectomy (RP). To determine whether the higher prostate specific antigen (PSA) recurrence rates were due solely to the higher positive margin rate, we examined whether obesity was an independent predictor of biochemical failure among men with negative surgical margins.

MATERIALS AND METHODS

We examined data from 1,250 men treated with RP between 1988 and 2003 at 5 equal access medical centers, of whom 731 had pathologically organ confined disease and negative surgical margins. Multivariate Cox proportional hazards analysis was used to determine if BMI was a significant independent predictor of biochemical recurrence.

RESULTS

Mean BMI significantly increased over time (p = 0.010). Black men were significantly more likely to be obese than white or nonwhite-nonblack men. After controlling for all preoperative characteristics, body mass index was a significant predictor of biochemical failure with moderately and severely obese men (BMI 35 kg/m2 or greater) having greater than a 4-fold increased risk of PSA failure (p = 0.035). After controlling for the higher pathological Gleason grades among obese men, body mass index remained a significant predictor of biochemical failure with moderately and severely obese men (BMI 35 kg/m2 or greater) having nearly a 4-fold increased risk for PSA failure (p = 0.036).

CONCLUSIONS

BMI 35 kg/m2 or greater was associated with higher grade tumors and worse outcome following RP in a cohort of men with favorable pathological findings. Thus, surgical technique (margin status) cannot fully explain the worse outcomes among obese men, suggesting that obesity may be associated with a biologically more aggressive form of prostate cancer.

Authors+Show Affiliations

Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD 21287-2101, USA. sfreedl1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15247719

Citation

Freedland, Stephen J., et al. "Obesity and Biochemical Outcome Following Radical Prostatectomy for Organ Confined Disease With Negative Surgical Margins." The Journal of Urology, vol. 172, no. 2, 2004, pp. 520-4.
Freedland SJ, Terris MK, Presti JC, et al. Obesity and biochemical outcome following radical prostatectomy for organ confined disease with negative surgical margins. J Urol. 2004;172(2):520-4.
Freedland, S. J., Terris, M. K., Presti, J. C., Amling, C. L., Kane, C. J., Trock, B., & Aronson, W. J. (2004). Obesity and biochemical outcome following radical prostatectomy for organ confined disease with negative surgical margins. The Journal of Urology, 172(2), pp. 520-4.
Freedland SJ, et al. Obesity and Biochemical Outcome Following Radical Prostatectomy for Organ Confined Disease With Negative Surgical Margins. J Urol. 2004;172(2):520-4. PubMed PMID: 15247719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obesity and biochemical outcome following radical prostatectomy for organ confined disease with negative surgical margins. AU - Freedland,Stephen J, AU - Terris,Martha K, AU - Presti,Joseph C,Jr AU - Amling,Christopher L, AU - Kane,Christopher J, AU - Trock,Bruce, AU - Aronson,William J, AU - ,, PY - 2004/7/13/pubmed PY - 2004/8/10/medline PY - 2004/7/13/entrez SP - 520 EP - 4 JF - The Journal of urology JO - J. Urol. VL - 172 IS - 2 N2 - PURPOSE: We have previously shown that men with a body mass index (BMI) greater than 35 kg/m2 had higher rates of positive surgical margins and significantly higher biochemical recurrence rates following radical prostatectomy (RP). To determine whether the higher prostate specific antigen (PSA) recurrence rates were due solely to the higher positive margin rate, we examined whether obesity was an independent predictor of biochemical failure among men with negative surgical margins. MATERIALS AND METHODS: We examined data from 1,250 men treated with RP between 1988 and 2003 at 5 equal access medical centers, of whom 731 had pathologically organ confined disease and negative surgical margins. Multivariate Cox proportional hazards analysis was used to determine if BMI was a significant independent predictor of biochemical recurrence. RESULTS: Mean BMI significantly increased over time (p = 0.010). Black men were significantly more likely to be obese than white or nonwhite-nonblack men. After controlling for all preoperative characteristics, body mass index was a significant predictor of biochemical failure with moderately and severely obese men (BMI 35 kg/m2 or greater) having greater than a 4-fold increased risk of PSA failure (p = 0.035). After controlling for the higher pathological Gleason grades among obese men, body mass index remained a significant predictor of biochemical failure with moderately and severely obese men (BMI 35 kg/m2 or greater) having nearly a 4-fold increased risk for PSA failure (p = 0.036). CONCLUSIONS: BMI 35 kg/m2 or greater was associated with higher grade tumors and worse outcome following RP in a cohort of men with favorable pathological findings. Thus, surgical technique (margin status) cannot fully explain the worse outcomes among obese men, suggesting that obesity may be associated with a biologically more aggressive form of prostate cancer. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/15247719/Obesity_and_biochemical_outcome_following_radical_prostatectomy_for_organ_confined_disease_with_negative_surgical_margins_ L2 - https://www.jurology.com/doi/full/10.1097/01.ju.0000135302.58378.ae?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -