Body Mass Index and Prostate Specific Antigen as Predictors of Adverse Pathology and Biochemical Recurrence After Prostatectomy

Lionel L. Bañez, Leon Sun, Bruce J. Trock, Misop Han, Alan W. Partin, William J. Aronson, Martha Kennedy Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling, Judd W. Moul, Stephen J. Freedland

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: Preoperative prostate specific antigen is widely used to predict unfavorable pathological features and biochemical relapse after radical prostatectomy. Recent reports that hemodilution may be responsible for lower prostate specific antigen in obese men led to concerns that prostate specific antigen may be less effective for prognosticating in men with increased body mass index. We determined whether the clinical usefulness of prostate specific antigen is negatively impacted by obesity by examining its operating characteristics and predictive accuracy as a function of body mass index. Materials and Methods: We performed a multicenter retrospective analysis of the records of 11,705 men who underwent radical prostatectomy from 1988 to 2007 from Veterans Affairs hospitals of the Shared Equal Access Regional Cancer Hospital Database, the Duke Prostate Center and Johns Hopkins Hospital. ROC curve analysis, the concordance index and the test for interaction were used to compare the ability of prostate specific antigen to predict unfavorable tumor characteristics and biochemical recurrence across body mass index categories. Results: There were no significant differences in the area under ROC curves across increasing body mass index categories for prostate specific antigen to predict pathological Gleason sum (7 or greater, 7 [4 + 3] or greater, or 8 or greater), positive surgical margins, extracapsular extension or seminal vesicle invasion in all 3 cohorts. There was no significant difference in prostate specific antigen accuracy to predict biochemical failure across increasing body mass index categories. Conclusions: In 3 cohorts of men treated with radical prostatectomy the ability of preoperative prostate specific antigen to predict adverse pathological features and posttreatment biochemical recurrence is not significantly affected by obesity. However, adjusting for obesity related hemodilution may still be required to properly interpret prostate specific antigen results in men with increased body mass index.

Original languageEnglish (US)
Pages (from-to)491-498
Number of pages8
JournalJournal of Urology
Volume182
Issue number2
DOIs
StatePublished - Aug 1 2009
Externally publishedYes

Fingerprint

Prostate-Specific Antigen
Prostatectomy
Body Mass Index
Pathology
Recurrence
ROC Curve
Hemodilution
Obesity
Veterans Hospitals
Cancer Care Facilities
Seminal Vesicles
Area Under Curve
Prostate
Databases

Keywords

  • hemodilution
  • obesity
  • prostate
  • prostate-specific antigen
  • prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Bañez, L. L., Sun, L., Trock, B. J., Han, M., Partin, A. W., Aronson, W. J., ... Freedland, S. J. (2009). Body Mass Index and Prostate Specific Antigen as Predictors of Adverse Pathology and Biochemical Recurrence After Prostatectomy. Journal of Urology, 182(2), 491-498. https://doi.org/10.1016/j.juro.2009.04.007

Body Mass Index and Prostate Specific Antigen as Predictors of Adverse Pathology and Biochemical Recurrence After Prostatectomy. / Bañez, Lionel L.; Sun, Leon; Trock, Bruce J.; Han, Misop; Partin, Alan W.; Aronson, William J.; Terris, Martha Kennedy; Presti, Joseph C.; Kane, Christopher J.; Amling, Christopher L.; Moul, Judd W.; Freedland, Stephen J.

In: Journal of Urology, Vol. 182, No. 2, 01.08.2009, p. 491-498.

Research output: Contribution to journalArticle

Bañez, LL, Sun, L, Trock, BJ, Han, M, Partin, AW, Aronson, WJ, Terris, MK, Presti, JC, Kane, CJ, Amling, CL, Moul, JW & Freedland, SJ 2009, 'Body Mass Index and Prostate Specific Antigen as Predictors of Adverse Pathology and Biochemical Recurrence After Prostatectomy', Journal of Urology, vol. 182, no. 2, pp. 491-498. https://doi.org/10.1016/j.juro.2009.04.007
Bañez, Lionel L. ; Sun, Leon ; Trock, Bruce J. ; Han, Misop ; Partin, Alan W. ; Aronson, William J. ; Terris, Martha Kennedy ; Presti, Joseph C. ; Kane, Christopher J. ; Amling, Christopher L. ; Moul, Judd W. ; Freedland, Stephen J. / Body Mass Index and Prostate Specific Antigen as Predictors of Adverse Pathology and Biochemical Recurrence After Prostatectomy. In: Journal of Urology. 2009 ; Vol. 182, No. 2. pp. 491-498.
@article{931b16970a3449ef82ec17255e1c132e,
title = "Body Mass Index and Prostate Specific Antigen as Predictors of Adverse Pathology and Biochemical Recurrence After Prostatectomy",
abstract = "Purpose: Preoperative prostate specific antigen is widely used to predict unfavorable pathological features and biochemical relapse after radical prostatectomy. Recent reports that hemodilution may be responsible for lower prostate specific antigen in obese men led to concerns that prostate specific antigen may be less effective for prognosticating in men with increased body mass index. We determined whether the clinical usefulness of prostate specific antigen is negatively impacted by obesity by examining its operating characteristics and predictive accuracy as a function of body mass index. Materials and Methods: We performed a multicenter retrospective analysis of the records of 11,705 men who underwent radical prostatectomy from 1988 to 2007 from Veterans Affairs hospitals of the Shared Equal Access Regional Cancer Hospital Database, the Duke Prostate Center and Johns Hopkins Hospital. ROC curve analysis, the concordance index and the test for interaction were used to compare the ability of prostate specific antigen to predict unfavorable tumor characteristics and biochemical recurrence across body mass index categories. Results: There were no significant differences in the area under ROC curves across increasing body mass index categories for prostate specific antigen to predict pathological Gleason sum (7 or greater, 7 [4 + 3] or greater, or 8 or greater), positive surgical margins, extracapsular extension or seminal vesicle invasion in all 3 cohorts. There was no significant difference in prostate specific antigen accuracy to predict biochemical failure across increasing body mass index categories. Conclusions: In 3 cohorts of men treated with radical prostatectomy the ability of preoperative prostate specific antigen to predict adverse pathological features and posttreatment biochemical recurrence is not significantly affected by obesity. However, adjusting for obesity related hemodilution may still be required to properly interpret prostate specific antigen results in men with increased body mass index.",
keywords = "hemodilution, obesity, prostate, prostate-specific antigen, prostatic neoplasms",
author = "Ba{\~n}ez, {Lionel L.} and Leon Sun and Trock, {Bruce J.} and Misop Han and Partin, {Alan W.} and Aronson, {William J.} and Terris, {Martha Kennedy} and Presti, {Joseph C.} and Kane, {Christopher J.} and Amling, {Christopher L.} and Moul, {Judd W.} and Freedland, {Stephen J.}",
year = "2009",
month = "8",
day = "1",
doi = "10.1016/j.juro.2009.04.007",
language = "English (US)",
volume = "182",
pages = "491--498",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Body Mass Index and Prostate Specific Antigen as Predictors of Adverse Pathology and Biochemical Recurrence After Prostatectomy

AU - Bañez, Lionel L.

AU - Sun, Leon

AU - Trock, Bruce J.

AU - Han, Misop

AU - Partin, Alan W.

AU - Aronson, William J.

AU - Terris, Martha Kennedy

AU - Presti, Joseph C.

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Moul, Judd W.

AU - Freedland, Stephen J.

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Purpose: Preoperative prostate specific antigen is widely used to predict unfavorable pathological features and biochemical relapse after radical prostatectomy. Recent reports that hemodilution may be responsible for lower prostate specific antigen in obese men led to concerns that prostate specific antigen may be less effective for prognosticating in men with increased body mass index. We determined whether the clinical usefulness of prostate specific antigen is negatively impacted by obesity by examining its operating characteristics and predictive accuracy as a function of body mass index. Materials and Methods: We performed a multicenter retrospective analysis of the records of 11,705 men who underwent radical prostatectomy from 1988 to 2007 from Veterans Affairs hospitals of the Shared Equal Access Regional Cancer Hospital Database, the Duke Prostate Center and Johns Hopkins Hospital. ROC curve analysis, the concordance index and the test for interaction were used to compare the ability of prostate specific antigen to predict unfavorable tumor characteristics and biochemical recurrence across body mass index categories. Results: There were no significant differences in the area under ROC curves across increasing body mass index categories for prostate specific antigen to predict pathological Gleason sum (7 or greater, 7 [4 + 3] or greater, or 8 or greater), positive surgical margins, extracapsular extension or seminal vesicle invasion in all 3 cohorts. There was no significant difference in prostate specific antigen accuracy to predict biochemical failure across increasing body mass index categories. Conclusions: In 3 cohorts of men treated with radical prostatectomy the ability of preoperative prostate specific antigen to predict adverse pathological features and posttreatment biochemical recurrence is not significantly affected by obesity. However, adjusting for obesity related hemodilution may still be required to properly interpret prostate specific antigen results in men with increased body mass index.

AB - Purpose: Preoperative prostate specific antigen is widely used to predict unfavorable pathological features and biochemical relapse after radical prostatectomy. Recent reports that hemodilution may be responsible for lower prostate specific antigen in obese men led to concerns that prostate specific antigen may be less effective for prognosticating in men with increased body mass index. We determined whether the clinical usefulness of prostate specific antigen is negatively impacted by obesity by examining its operating characteristics and predictive accuracy as a function of body mass index. Materials and Methods: We performed a multicenter retrospective analysis of the records of 11,705 men who underwent radical prostatectomy from 1988 to 2007 from Veterans Affairs hospitals of the Shared Equal Access Regional Cancer Hospital Database, the Duke Prostate Center and Johns Hopkins Hospital. ROC curve analysis, the concordance index and the test for interaction were used to compare the ability of prostate specific antigen to predict unfavorable tumor characteristics and biochemical recurrence across body mass index categories. Results: There were no significant differences in the area under ROC curves across increasing body mass index categories for prostate specific antigen to predict pathological Gleason sum (7 or greater, 7 [4 + 3] or greater, or 8 or greater), positive surgical margins, extracapsular extension or seminal vesicle invasion in all 3 cohorts. There was no significant difference in prostate specific antigen accuracy to predict biochemical failure across increasing body mass index categories. Conclusions: In 3 cohorts of men treated with radical prostatectomy the ability of preoperative prostate specific antigen to predict adverse pathological features and posttreatment biochemical recurrence is not significantly affected by obesity. However, adjusting for obesity related hemodilution may still be required to properly interpret prostate specific antigen results in men with increased body mass index.

KW - hemodilution

KW - obesity

KW - prostate

KW - prostate-specific antigen

KW - prostatic neoplasms

UR - http://www.scopus.com/inward/record.url?scp=67649819338&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67649819338&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2009.04.007

DO - 10.1016/j.juro.2009.04.007

M3 - Article

VL - 182

SP - 491

EP - 498

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 2

ER -