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

Stephen J. Freedland, Leon Sun, Christopher J. Kane, Joseph C. Presti, Martha Kennedy Terris, Christopher L. Amling, Judd W. Moul, William J. Aronson

Research output: Contribution to journalArticle

38 Citations (Scopus)

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 (≥2000 vs <2000). RESULTS: In both cohorts a higher BMI was associated with high-grade disease (P ≤ 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 ≤ 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 ≤ 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 ≤ 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.

Original languageEnglish (US)
Pages (from-to)969-974
Number of pages6
JournalBJU International
Volume102
Issue number8
DOIs
StatePublished - Oct 1 2008

Fingerprint

Cancer Care Facilities
Prostate-Specific Antigen
Prostatectomy
Early Detection of Cancer
Prostate
Prostatic Neoplasms
Obesity
Databases
Digital Rectal Examination
Body Mass Index
Neoplasms
Hemodilution
Delayed Diagnosis
Proportional Hazards Models
Cohort Studies
Retrospective Studies
Logistic Models
Biopsy

Keywords

  • Biochemical progression
  • Obesity
  • PSA
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

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. / Freedland, Stephen J.; Sun, Leon; Kane, Christopher J.; Presti, Joseph C.; Terris, Martha Kennedy; Amling, Christopher L.; Moul, Judd W.; Aronson, William J.

In: BJU International, Vol. 102, No. 8, 01.10.2008, p. 969-974.

Research output: Contribution to journalArticle

Freedland, Stephen J. ; Sun, Leon ; Kane, Christopher J. ; Presti, Joseph C. ; Terris, Martha Kennedy ; Amling, Christopher L. ; Moul, Judd W. ; Aronson, William J. / 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. In: BJU International. 2008 ; Vol. 102, No. 8. pp. 969-974.
@article{61c16dc2be0b4d1ba260bfc2a876508c,
title = "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",
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 (≥2000 vs <2000). RESULTS: In both cohorts a higher BMI was associated with high-grade disease (P ≤ 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 ≤ 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 ≤ 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 ≤ 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.",
keywords = "Biochemical progression, Obesity, PSA, Prostate cancer, Radical prostatectomy",
author = "Freedland, {Stephen J.} and Leon Sun and Kane, {Christopher J.} and Presti, {Joseph C.} and Terris, {Martha Kennedy} and Amling, {Christopher L.} and Moul, {Judd W.} and Aronson, {William J.}",
year = "2008",
month = "10",
day = "1",
doi = "10.1111/j.1464-410X.2008.07934.x",
language = "English (US)",
volume = "102",
pages = "969--974",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Obesity and oncological outcome after radical prostatectomy

T2 - 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.

AU - Terris, Martha Kennedy

AU - Amling, Christopher L.

AU - Moul, Judd W.

AU - Aronson, William J.

PY - 2008/10/1

Y1 - 2008/10/1

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 (≥2000 vs <2000). RESULTS: In both cohorts a higher BMI was associated with high-grade disease (P ≤ 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 ≤ 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 ≤ 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 ≤ 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.

AB - 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 (≥2000 vs <2000). RESULTS: In both cohorts a higher BMI was associated with high-grade disease (P ≤ 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 ≤ 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 ≤ 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 ≤ 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.

KW - Biochemical progression

KW - Obesity

KW - PSA

KW - Prostate cancer

KW - Radical prostatectomy

UR - http://www.scopus.com/inward/record.url?scp=52649086329&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=52649086329&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2008.07934.x

DO - 10.1111/j.1464-410X.2008.07934.x

M3 - Article

VL - 102

SP - 969

EP - 974

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 8

ER -