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Obesity and oncological outcome after radical prostatectomy: impact of prostate-specific antigen-based prostate cancer screening: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases.
BJU Int 2008; 102(8):969-74BI

Abstract

OBJECTIVE

To indirectly test the hypothesis that prostate-specific antigen (PSA)-based screening is biased against obese men due to haemodilution of PSA, and thus results in delayed diagnosis and poorer outcome beyond the biological link between obesity and aggressive prostate cancer.

PATIENTS AND METHODS

We sought to examine the association between body mass index (BMI) and the outcome of radical prostatectomy (RP) separately for men with PSA-detected cancers (cT1c) or with abnormal digital rectal examination (DRE) findings (cT2/T3), and stratified by year of treatment, using two large databases. We conducted a retrospective cohort study of 1375 and 2014 men treated by RP between 1988 and 2007 using the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases. We evaluated the association between BMI and adverse pathological features and biochemical progression, using logistic regression and Cox proportional hazards models, adjusting for several clinical characteristics, respectively. Data were examined as a whole and as stratified by clinical stage (cT1c vs cT2/T3) and year of surgery (>or=2000 vs <2000).

RESULTS

In both cohorts a higher BMI was associated with high-grade disease (P <or= 0.02) and positive surgical margins (P < 0.001) and these results did not vary by clinical stage. A higher BMI was significantly associated with biochemical progression (P <or= 0.03) in both cohorts. When stratified by clinical stage, obesity was significantly related to progression in both cohorts among men with T1c cancers (P <or= 0.004) but not in men with cT2/T3 cancers (P > 0.3). Among men with T1c disease, the association between BMI and biochemical progression was limited to men treated in 2000 or later (P <or= 0.002) and was not apparent in men treated before 2000 (P > 0.4).

CONCLUSIONS

Obese men with PSA-detected cancers and treated with RP since 2000 were at significantly greater risk of biochemical progression, while obese men treated before 2000 or diagnosed with an abnormal DRE were not at significantly greater risk of progression. These findings support the hypothesis that current PSA-based screening is less effective at finding cancers in obese men, leading to more aggressive tumours at diagnosis. Lowering the PSA threshold for biopsy among obese men might help to improve outcomes among this high-risk group.

Authors+Show Affiliations

Urology Section, Department of Surgery, Veterans Affairs Medical Center, Duke University Medical Center, Durham, NC 27710, USA. steve.freedland@duke.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
Multicenter Study

Language

eng

PubMed ID

18691175

Citation

Freedland, Stephen J., et al. "Obesity and Oncological Outcome After Radical Prostatectomy: Impact of Prostate-specific Antigen-based Prostate Cancer Screening: Results From the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center Databases." BJU International, vol. 102, no. 8, 2008, pp. 969-74.
Freedland SJ, Sun L, Kane CJ, et al. Obesity and oncological outcome after radical prostatectomy: impact of prostate-specific antigen-based prostate cancer screening: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases. BJU Int. 2008;102(8):969-74.
Freedland, S. J., Sun, L., Kane, C. J., Presti, J. C., Terris, M. K., Amling, C. L., ... Aronson, W. J. (2008). Obesity and oncological outcome after radical prostatectomy: impact of prostate-specific antigen-based prostate cancer screening: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases. BJU International, 102(8), pp. 969-74. doi:10.1111/j.1464-410X.2008.07934.x.
Freedland SJ, et al. Obesity and Oncological Outcome After Radical Prostatectomy: Impact of Prostate-specific Antigen-based Prostate Cancer Screening: Results From the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center Databases. BJU Int. 2008;102(8):969-74. PubMed PMID: 18691175.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obesity and oncological outcome after radical prostatectomy: impact of prostate-specific antigen-based prostate cancer screening: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases. AU - Freedland,Stephen J, AU - Sun,Leon, AU - Kane,Christopher J, AU - Presti,Joseph C,Jr AU - Terris,Martha K, AU - Amling,Christopher L, AU - Moul,Judd W, AU - Aronson,William J, Y1 - 2008/08/07/ PY - 2008/8/12/pubmed PY - 2008/11/8/medline PY - 2008/8/12/entrez SP - 969 EP - 74 JF - BJU international JO - BJU Int. VL - 102 IS - 8 N2 - OBJECTIVE: To indirectly test the hypothesis that prostate-specific antigen (PSA)-based screening is biased against obese men due to haemodilution of PSA, and thus results in delayed diagnosis and poorer outcome beyond the biological link between obesity and aggressive prostate cancer. PATIENTS AND METHODS: We sought to examine the association between body mass index (BMI) and the outcome of radical prostatectomy (RP) separately for men with PSA-detected cancers (cT1c) or with abnormal digital rectal examination (DRE) findings (cT2/T3), and stratified by year of treatment, using two large databases. We conducted a retrospective cohort study of 1375 and 2014 men treated by RP between 1988 and 2007 using the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases. We evaluated the association between BMI and adverse pathological features and biochemical progression, using logistic regression and Cox proportional hazards models, adjusting for several clinical characteristics, respectively. Data were examined as a whole and as stratified by clinical stage (cT1c vs cT2/T3) and year of surgery (>or=2000 vs <2000). RESULTS: In both cohorts a higher BMI was associated with high-grade disease (P <or= 0.02) and positive surgical margins (P < 0.001) and these results did not vary by clinical stage. A higher BMI was significantly associated with biochemical progression (P <or= 0.03) in both cohorts. When stratified by clinical stage, obesity was significantly related to progression in both cohorts among men with T1c cancers (P <or= 0.004) but not in men with cT2/T3 cancers (P > 0.3). Among men with T1c disease, the association between BMI and biochemical progression was limited to men treated in 2000 or later (P <or= 0.002) and was not apparent in men treated before 2000 (P > 0.4). CONCLUSIONS: Obese men with PSA-detected cancers and treated with RP since 2000 were at significantly greater risk of biochemical progression, while obese men treated before 2000 or diagnosed with an abnormal DRE were not at significantly greater risk of progression. These findings support the hypothesis that current PSA-based screening is less effective at finding cancers in obese men, leading to more aggressive tumours at diagnosis. Lowering the PSA threshold for biopsy among obese men might help to improve outcomes among this high-risk group. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/18691175/Obesity_and_oncological_outcome_after_radical_prostatectomy:_impact_of_prostate_specific_antigen_based_prostate_cancer_screening:_results_from_the_Shared_Equal_Access_Regional_Cancer_Hospital_and_Duke_Prostate_Center_databases_ L2 - https://doi.org/10.1111/j.1464-410X.2008.07934.x DB - PRIME DP - Unbound Medicine ER -