Association of Obesity-Related Hemodilution of Prostate-Specific Antigen, Dihydrotestosterone, and Testosterone

Zachary W A Klaassen, Lauren E. Howard, Daniel M. Moreira, Gerald L. Andriole, Martha Kennedy Terris, Stephen J. Freedland

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: Prostate-specific antigen (PSA) hemodilution is the leading theory for lower PSA values in obese men. However, testosterone and dihydrotestosterone (DHT), which are necessary for PSA production, are reduced in obese men. We assessed the relationship of body mass index (BMI) and PSA, taking into consideration the effect of testosterone and DHT. METHODS: Among 8,122 participants in Reduction by Dutasteride of Prostate Cancer Events (REDUCE), complete data were available for 7,275. BMI was categorized as normal (<25 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), or moderate + severely obese (≥35 kg/m2). Associations between BMI, testosterone, and DHT and the outcome variable of PSA were examined using linear regression. RESULTS: There were 1,964 (27.0%) normal weight, 3,826 (52.6%) overweight, 1,200 (16.5%) obese, and 285 (3.9%) moderately + severely obese patients. With increasing BMI, there was a progressive decrease in PSA (P = 0.02), increase in prostate volume (P < 0.001), and decrease in both testosterone (P < 0.001) and DHT (P < 0.001). Using linear regression, increasing BMI was associated with decreasing serum PSA values. Furthermore, BMI remained inversely associated with PSA after individually adjusting for testosterone and DHT, as well as when adjusting for testosterone and DHT in the same model. Decreased androgen levels accounted for only 19% of the lower PSA in men with higher BMI. CONCLUSIONS: Only a fraction of lower PSA in obese men could be attributed to testosterone and DHT levels. The remaining factors explaining lower PSA are unaccounted for, presumably secondary to hemodilution associated with increased plasma volume in obese men. Prostate 77:466–470, 2017.

Original languageEnglish (US)
Pages (from-to)466-470
Number of pages5
JournalProstate
Volume77
Issue number5
DOIs
StatePublished - Apr 1 2017

Fingerprint

Hemodilution
Dihydrotestosterone
Prostate-Specific Antigen
Testosterone
Obesity
Body Mass Index
Prostate
Linear Models
Plasma Volume
Androgens
Prostatic Neoplasms

Keywords

  • PSA
  • dihydrotestosterone
  • hemodilution
  • obesity
  • testosterone

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Association of Obesity-Related Hemodilution of Prostate-Specific Antigen, Dihydrotestosterone, and Testosterone. / Klaassen, Zachary W A; Howard, Lauren E.; Moreira, Daniel M.; Andriole, Gerald L.; Terris, Martha Kennedy; Freedland, Stephen J.

In: Prostate, Vol. 77, No. 5, 01.04.2017, p. 466-470.

Research output: Contribution to journalArticle

Klaassen, Zachary W A ; Howard, Lauren E. ; Moreira, Daniel M. ; Andriole, Gerald L. ; Terris, Martha Kennedy ; Freedland, Stephen J. / Association of Obesity-Related Hemodilution of Prostate-Specific Antigen, Dihydrotestosterone, and Testosterone. In: Prostate. 2017 ; Vol. 77, No. 5. pp. 466-470.
@article{e4d389fe20b74615af5044941a293e95,
title = "Association of Obesity-Related Hemodilution of Prostate-Specific Antigen, Dihydrotestosterone, and Testosterone",
abstract = "BACKGROUND: Prostate-specific antigen (PSA) hemodilution is the leading theory for lower PSA values in obese men. However, testosterone and dihydrotestosterone (DHT), which are necessary for PSA production, are reduced in obese men. We assessed the relationship of body mass index (BMI) and PSA, taking into consideration the effect of testosterone and DHT. METHODS: Among 8,122 participants in Reduction by Dutasteride of Prostate Cancer Events (REDUCE), complete data were available for 7,275. BMI was categorized as normal (<25 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), or moderate + severely obese (≥35 kg/m2). Associations between BMI, testosterone, and DHT and the outcome variable of PSA were examined using linear regression. RESULTS: There were 1,964 (27.0{\%}) normal weight, 3,826 (52.6{\%}) overweight, 1,200 (16.5{\%}) obese, and 285 (3.9{\%}) moderately + severely obese patients. With increasing BMI, there was a progressive decrease in PSA (P = 0.02), increase in prostate volume (P < 0.001), and decrease in both testosterone (P < 0.001) and DHT (P < 0.001). Using linear regression, increasing BMI was associated with decreasing serum PSA values. Furthermore, BMI remained inversely associated with PSA after individually adjusting for testosterone and DHT, as well as when adjusting for testosterone and DHT in the same model. Decreased androgen levels accounted for only 19{\%} of the lower PSA in men with higher BMI. CONCLUSIONS: Only a fraction of lower PSA in obese men could be attributed to testosterone and DHT levels. The remaining factors explaining lower PSA are unaccounted for, presumably secondary to hemodilution associated with increased plasma volume in obese men. Prostate 77:466–470, 2017.",
keywords = "PSA, dihydrotestosterone, hemodilution, obesity, testosterone",
author = "Klaassen, {Zachary W A} and Howard, {Lauren E.} and Moreira, {Daniel M.} and Andriole, {Gerald L.} and Terris, {Martha Kennedy} and Freedland, {Stephen J.}",
year = "2017",
month = "4",
day = "1",
doi = "10.1002/pros.23285",
language = "English (US)",
volume = "77",
pages = "466--470",
journal = "Prostate",
issn = "0270-4137",
publisher = "Wiley-Liss Inc.",
number = "5",

}

TY - JOUR

T1 - Association of Obesity-Related Hemodilution of Prostate-Specific Antigen, Dihydrotestosterone, and Testosterone

AU - Klaassen, Zachary W A

AU - Howard, Lauren E.

AU - Moreira, Daniel M.

AU - Andriole, Gerald L.

AU - Terris, Martha Kennedy

AU - Freedland, Stephen J.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - BACKGROUND: Prostate-specific antigen (PSA) hemodilution is the leading theory for lower PSA values in obese men. However, testosterone and dihydrotestosterone (DHT), which are necessary for PSA production, are reduced in obese men. We assessed the relationship of body mass index (BMI) and PSA, taking into consideration the effect of testosterone and DHT. METHODS: Among 8,122 participants in Reduction by Dutasteride of Prostate Cancer Events (REDUCE), complete data were available for 7,275. BMI was categorized as normal (<25 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), or moderate + severely obese (≥35 kg/m2). Associations between BMI, testosterone, and DHT and the outcome variable of PSA were examined using linear regression. RESULTS: There were 1,964 (27.0%) normal weight, 3,826 (52.6%) overweight, 1,200 (16.5%) obese, and 285 (3.9%) moderately + severely obese patients. With increasing BMI, there was a progressive decrease in PSA (P = 0.02), increase in prostate volume (P < 0.001), and decrease in both testosterone (P < 0.001) and DHT (P < 0.001). Using linear regression, increasing BMI was associated with decreasing serum PSA values. Furthermore, BMI remained inversely associated with PSA after individually adjusting for testosterone and DHT, as well as when adjusting for testosterone and DHT in the same model. Decreased androgen levels accounted for only 19% of the lower PSA in men with higher BMI. CONCLUSIONS: Only a fraction of lower PSA in obese men could be attributed to testosterone and DHT levels. The remaining factors explaining lower PSA are unaccounted for, presumably secondary to hemodilution associated with increased plasma volume in obese men. Prostate 77:466–470, 2017.

AB - BACKGROUND: Prostate-specific antigen (PSA) hemodilution is the leading theory for lower PSA values in obese men. However, testosterone and dihydrotestosterone (DHT), which are necessary for PSA production, are reduced in obese men. We assessed the relationship of body mass index (BMI) and PSA, taking into consideration the effect of testosterone and DHT. METHODS: Among 8,122 participants in Reduction by Dutasteride of Prostate Cancer Events (REDUCE), complete data were available for 7,275. BMI was categorized as normal (<25 kg/m2), overweight (25–29.9 kg/m2), obese (30–34.9 kg/m2), or moderate + severely obese (≥35 kg/m2). Associations between BMI, testosterone, and DHT and the outcome variable of PSA were examined using linear regression. RESULTS: There were 1,964 (27.0%) normal weight, 3,826 (52.6%) overweight, 1,200 (16.5%) obese, and 285 (3.9%) moderately + severely obese patients. With increasing BMI, there was a progressive decrease in PSA (P = 0.02), increase in prostate volume (P < 0.001), and decrease in both testosterone (P < 0.001) and DHT (P < 0.001). Using linear regression, increasing BMI was associated with decreasing serum PSA values. Furthermore, BMI remained inversely associated with PSA after individually adjusting for testosterone and DHT, as well as when adjusting for testosterone and DHT in the same model. Decreased androgen levels accounted for only 19% of the lower PSA in men with higher BMI. CONCLUSIONS: Only a fraction of lower PSA in obese men could be attributed to testosterone and DHT levels. The remaining factors explaining lower PSA are unaccounted for, presumably secondary to hemodilution associated with increased plasma volume in obese men. Prostate 77:466–470, 2017.

KW - PSA

KW - dihydrotestosterone

KW - hemodilution

KW - obesity

KW - testosterone

UR - http://www.scopus.com/inward/record.url?scp=85007201670&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007201670&partnerID=8YFLogxK

U2 - 10.1002/pros.23285

DO - 10.1002/pros.23285

M3 - Article

C2 - 27990661

AN - SCOPUS:85007201670

VL - 77

SP - 466

EP - 470

JO - Prostate

JF - Prostate

SN - 0270-4137

IS - 5

ER -