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Obesity is associated with risk of progression for low-risk prostate cancers managed expectantly.
Eur Urol. 2014 Nov; 66(5):841-8.EU

Abstract

BACKGROUND

Active surveillance (AS) is an expectant management strategy for prostate cancer (PCa). The impact of obesity on progression is not well characterized in this population.

OBJECTIVE

To determine if obesity is associated with progression in men on AS for low-risk PCa.

DESIGN, SETTING, AND PARTICIPANTS

Men undergoing AS for low-risk PCa (no Gleason pattern ≥4, three or fewer cores involved or one-third or less of the total number of cores involved, and no core with >50% cancer involvement) were identified at our institution.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The outcomes were pathologic progression (defined as no longer meeting low-risk criteria on follow-up biopsy) and therapeutic progression (defined as intent to initiate active treatment). Kaplan-Meier curves and multivariable logistic regression and Cox proportional hazards models were used, with separate models for reclassification at confirmatory biopsy (first biopsy after diagnostic biopsy) and progression beyond confirmatory biopsy.

RESULTS AND LIMITATIONS

In this cohort of 565 men (median follow-up: 48 mo), 124 (22%) were obese (body mass index [BMI] ≥30kg/m(2)). Pathologic and therapeutic progression occurred in 168 men (30%) and 172 men (30%), respectively. No association was noted between obesity and risk of progression at the confirmatory biopsy. However, beyond confirmatory biopsy, obesity was associated with a greater probability of pathologic progression (p=0.007) and therapeutic progression (p=0.007) in Kaplan-Meier analyses. In adjusted Cox models, each 5-unit increase in BMI was associated with an increased risk of pathologic progression (hazard ratio [HR]: 1.5; 95% confidence interval [CI], 1.1-2.1; p=0.02) and therapeutic progression (HR: 1.4; 95% CI, 1.0-1.9; p=0.05). The main limitation is the retrospective design, limiting the ability to assess BMI changes over time.

CONCLUSIONS

Obesity was associated with a significantly increased risk of progression beyond the confirmatory biopsy. This suggests an increased risk of long-term biologic progression rather than solely misclassification.

PATIENT SUMMARY

As opposed to immediate active treatment (surgery or radiation), active surveillance (AS) involves closely monitoring low-risk prostate cancers and only using active treatment if there are signs of progression. Our study is the first to suggest that obesity is associated with a higher risk of cancer progression while on AS. Further research is needed to determine if diet and exercise can decrease the risk of cancer progression while on AS.

Authors+Show Affiliations

Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: bimal.bhindi@mail.utoronto.ca.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical and Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

24954793

Citation

Bhindi, Bimal, et al. "Obesity Is Associated With Risk of Progression for Low-risk Prostate Cancers Managed Expectantly." European Urology, vol. 66, no. 5, 2014, pp. 841-8.
Bhindi B, Kulkarni GS, Finelli A, et al. Obesity is associated with risk of progression for low-risk prostate cancers managed expectantly. Eur Urol. 2014;66(5):841-8.
Bhindi, B., Kulkarni, G. S., Finelli, A., Alibhai, S. M., Hamilton, R. J., Toi, A., van der Kwast, T. H., Evans, A., Hersey, K., Jewett, M. A., Zlotta, A. R., Trachtenberg, J., & Fleshner, N. E. (2014). Obesity is associated with risk of progression for low-risk prostate cancers managed expectantly. European Urology, 66(5), 841-8. https://doi.org/10.1016/j.eururo.2014.06.005
Bhindi B, et al. Obesity Is Associated With Risk of Progression for Low-risk Prostate Cancers Managed Expectantly. Eur Urol. 2014;66(5):841-8. PubMed PMID: 24954793.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obesity is associated with risk of progression for low-risk prostate cancers managed expectantly. AU - Bhindi,Bimal, AU - Kulkarni,Girish S, AU - Finelli,Antonio, AU - Alibhai,Shabbir M H, AU - Hamilton,Robert J, AU - Toi,Ants, AU - van der Kwast,Theodorus H, AU - Evans,Andrew, AU - Hersey,Karen, AU - Jewett,Michael A S, AU - Zlotta,Alexandre R, AU - Trachtenberg,John, AU - Fleshner,Neil E, Y1 - 2014/06/18/ PY - 2014/03/18/received PY - 2014/06/02/accepted PY - 2014/6/24/entrez PY - 2014/6/24/pubmed PY - 2015/11/3/medline KW - Active surveillance KW - Obesity KW - Prostatic neoplasms KW - Watchful waiting SP - 841 EP - 8 JF - European urology JO - Eur. Urol. VL - 66 IS - 5 N2 - BACKGROUND: Active surveillance (AS) is an expectant management strategy for prostate cancer (PCa). The impact of obesity on progression is not well characterized in this population. OBJECTIVE: To determine if obesity is associated with progression in men on AS for low-risk PCa. DESIGN, SETTING, AND PARTICIPANTS: Men undergoing AS for low-risk PCa (no Gleason pattern ≥4, three or fewer cores involved or one-third or less of the total number of cores involved, and no core with >50% cancer involvement) were identified at our institution. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcomes were pathologic progression (defined as no longer meeting low-risk criteria on follow-up biopsy) and therapeutic progression (defined as intent to initiate active treatment). Kaplan-Meier curves and multivariable logistic regression and Cox proportional hazards models were used, with separate models for reclassification at confirmatory biopsy (first biopsy after diagnostic biopsy) and progression beyond confirmatory biopsy. RESULTS AND LIMITATIONS: In this cohort of 565 men (median follow-up: 48 mo), 124 (22%) were obese (body mass index [BMI] ≥30kg/m(2)). Pathologic and therapeutic progression occurred in 168 men (30%) and 172 men (30%), respectively. No association was noted between obesity and risk of progression at the confirmatory biopsy. However, beyond confirmatory biopsy, obesity was associated with a greater probability of pathologic progression (p=0.007) and therapeutic progression (p=0.007) in Kaplan-Meier analyses. In adjusted Cox models, each 5-unit increase in BMI was associated with an increased risk of pathologic progression (hazard ratio [HR]: 1.5; 95% confidence interval [CI], 1.1-2.1; p=0.02) and therapeutic progression (HR: 1.4; 95% CI, 1.0-1.9; p=0.05). The main limitation is the retrospective design, limiting the ability to assess BMI changes over time. CONCLUSIONS: Obesity was associated with a significantly increased risk of progression beyond the confirmatory biopsy. This suggests an increased risk of long-term biologic progression rather than solely misclassification. PATIENT SUMMARY: As opposed to immediate active treatment (surgery or radiation), active surveillance (AS) involves closely monitoring low-risk prostate cancers and only using active treatment if there are signs of progression. Our study is the first to suggest that obesity is associated with a higher risk of cancer progression while on AS. Further research is needed to determine if diet and exercise can decrease the risk of cancer progression while on AS. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/24954793/Obesity_is_associated_with_risk_of_progression_for_low_risk_prostate_cancers_managed_expectantly_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(14)00526-0 DB - PRIME DP - Unbound Medicine ER -