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Obesity and prostate cancer: weighing the evidence.

Abstract

CONTEXT

Obesity and prostate cancer (PCa) affect substantial proportions of Western society. Mounting evidence, both epidemiologic and mechanistic, for an association between the two is of public health interest. An improved understanding of the role of this modifiable risk factor in PCa etiology is imperative to optimize screening, treatment, and prevention.

OBJECTIVE

To consolidate and evaluate the evidence for an epidemiologic link between obesity and PCa, in addition to examining the proposed underlying molecular mechanisms.

EVIDENCE ACQUISITION

A PubMed search for relevant articles published between 1991 and July 2012 was performed by combining the following terms: obesity, BMI, body mass index and prostate cancer risk, prostate cancer incidence, prostate cancer mortality, radical prostatectomy, androgen-deprivation therapy, external-beam radiation, brachytherapy, prostate cancer and quality of life, prostate cancer and active surveillance, in addition to obesity, BMI, body mass index and prostate cancer and insulin, insulin-like growth factor, androgen, estradiol, leptin, adiponectin, and IL-6. Articles were selected based on content, date of publication, and relevancy, and their references were also searched for relevant articles.

EVIDENCE SYNTHESIS

Increasing evidence suggests obesity is associated with elevated incidence of aggressive PCa, increased risk of biochemical failure following radical prostatectomy and external-beam radiotherapy, higher frequency of complications following androgen-deprivation therapy, and increased PCa-specific mortality, although perhaps a lower overall PCa incidence. These results may in part relate to difficulties in detecting and treating obese men. However, multiple molecular mechanisms could explain these associations as well. Weight loss slows PCa in animal models but has yet to be fully tested in human trials.

CONCLUSIONS

Obesity appears to be linked with aggressive PCa. We suggest clinical tips to better diagnose and treat obese men with PCa. Whether reversing obesity slows PCa growth is currently unknown, although it is an active area of research.

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  • Authors+Show Affiliations

    ,

    Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.

    ,

    Source

    European urology 63:5 2013 May pg 800-9

    MeSH

    Adipose Tissue
    Animals
    Antineoplastic Agents
    Body Mass Index
    Brachytherapy
    Caloric Restriction
    Exercise
    Humans
    Male
    Obesity
    Prostatectomy
    Prostatic Neoplasms
    Risk Assessment
    Risk Factors
    Risk Reduction Behavior
    Time Factors
    Treatment Outcome
    Watchful Waiting
    Weight Loss

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, P.H.S.
    Review

    Language

    eng

    PubMed ID

    23219374

    Citation

    Allott, Emma H., et al. "Obesity and Prostate Cancer: Weighing the Evidence." European Urology, vol. 63, no. 5, 2013, pp. 800-9.
    Allott EH, Masko EM, Freedland SJ. Obesity and prostate cancer: weighing the evidence. Eur Urol. 2013;63(5):800-9.
    Allott, E. H., Masko, E. M., & Freedland, S. J. (2013). Obesity and prostate cancer: weighing the evidence. European Urology, 63(5), pp. 800-9. doi:10.1016/j.eururo.2012.11.013.
    Allott EH, Masko EM, Freedland SJ. Obesity and Prostate Cancer: Weighing the Evidence. Eur Urol. 2013;63(5):800-9. PubMed PMID: 23219374.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Obesity and prostate cancer: weighing the evidence. AU - Allott,Emma H, AU - Masko,Elizabeth M, AU - Freedland,Stephen J, Y1 - 2012/11/15/ PY - 2012/09/12/received PY - 2012/11/07/accepted PY - 2012/12/11/entrez PY - 2012/12/12/pubmed PY - 2013/9/26/medline SP - 800 EP - 9 JF - European urology JO - Eur. Urol. VL - 63 IS - 5 N2 - CONTEXT: Obesity and prostate cancer (PCa) affect substantial proportions of Western society. Mounting evidence, both epidemiologic and mechanistic, for an association between the two is of public health interest. An improved understanding of the role of this modifiable risk factor in PCa etiology is imperative to optimize screening, treatment, and prevention. OBJECTIVE: To consolidate and evaluate the evidence for an epidemiologic link between obesity and PCa, in addition to examining the proposed underlying molecular mechanisms. EVIDENCE ACQUISITION: A PubMed search for relevant articles published between 1991 and July 2012 was performed by combining the following terms: obesity, BMI, body mass index and prostate cancer risk, prostate cancer incidence, prostate cancer mortality, radical prostatectomy, androgen-deprivation therapy, external-beam radiation, brachytherapy, prostate cancer and quality of life, prostate cancer and active surveillance, in addition to obesity, BMI, body mass index and prostate cancer and insulin, insulin-like growth factor, androgen, estradiol, leptin, adiponectin, and IL-6. Articles were selected based on content, date of publication, and relevancy, and their references were also searched for relevant articles. EVIDENCE SYNTHESIS: Increasing evidence suggests obesity is associated with elevated incidence of aggressive PCa, increased risk of biochemical failure following radical prostatectomy and external-beam radiotherapy, higher frequency of complications following androgen-deprivation therapy, and increased PCa-specific mortality, although perhaps a lower overall PCa incidence. These results may in part relate to difficulties in detecting and treating obese men. However, multiple molecular mechanisms could explain these associations as well. Weight loss slows PCa in animal models but has yet to be fully tested in human trials. CONCLUSIONS: Obesity appears to be linked with aggressive PCa. We suggest clinical tips to better diagnose and treat obese men with PCa. Whether reversing obesity slows PCa growth is currently unknown, although it is an active area of research. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/23219374/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(12)01344-9 DB - PRIME DP - Unbound Medicine ER -