Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy

Biology or Technique? Results from the SEARCH database

Tammy Ho, Leah Gerber, William J. Aronson, Martha Kennedy Terris, Joseph C. Presti, Christopher J. Kane, Christopher L. Amling, Stephen J. Freedland

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. Objective: To examine whether obesity predicts higher prostate-specific antigen (PSA) nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. Design, setting, and participants: A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration-based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. Intervention: All patients underwent RP. Outcome measurements and statistical analysis: We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA nadir. Results and limitations: Mean BMI was 28.5 kg/m2. Higher BMI was associated with higher PSA nadir on both univariable (p = 0.001) and multivariable analyses (p < 0.001). Increased BMI was associated with increased BCR risk (hazard ratio [HR]: 1.06; p = 0.007). Adjusting for PSA nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p = 0.043). When stratified by PSA nadir, obesity only significantly predicted BCR in men with an undetectable nadir (p = 0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Conclusions: Obese men are more likely to have a higher PSA nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.

Original languageEnglish (US)
Pages (from-to)910-916
Number of pages7
JournalEuropean Urology
Volume62
Issue number5
DOIs
StatePublished - Nov 1 2012

Fingerprint

Prostate-Specific Antigen
Prostatectomy
Obesity
Databases
Recurrence
Body Mass Index
Cancer Care Facilities
United States Department of Veterans Affairs
Biological Factors
Proportional Hazards Models
Prostatic Neoplasms
Odds Ratio
Neoplasm Metastasis
Mortality

Keywords

  • Biochemical recurrence
  • Obesity
  • PSA nadir
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy : Biology or Technique? Results from the SEARCH database. / Ho, Tammy; Gerber, Leah; Aronson, William J.; Terris, Martha Kennedy; Presti, Joseph C.; Kane, Christopher J.; Amling, Christopher L.; Freedland, Stephen J.

In: European Urology, Vol. 62, No. 5, 01.11.2012, p. 910-916.

Research output: Contribution to journalArticle

Ho, Tammy ; Gerber, Leah ; Aronson, William J. ; Terris, Martha Kennedy ; Presti, Joseph C. ; Kane, Christopher J. ; Amling, Christopher L. ; Freedland, Stephen J. / Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy : Biology or Technique? Results from the SEARCH database. In: European Urology. 2012 ; Vol. 62, No. 5. pp. 910-916.
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abstract = "Background: Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. Objective: To examine whether obesity predicts higher prostate-specific antigen (PSA) nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. Design, setting, and participants: A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration-based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. Intervention: All patients underwent RP. Outcome measurements and statistical analysis: We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA nadir. Results and limitations: Mean BMI was 28.5 kg/m2. Higher BMI was associated with higher PSA nadir on both univariable (p = 0.001) and multivariable analyses (p < 0.001). Increased BMI was associated with increased BCR risk (hazard ratio [HR]: 1.06; p = 0.007). Adjusting for PSA nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p = 0.043). When stratified by PSA nadir, obesity only significantly predicted BCR in men with an undetectable nadir (p = 0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Conclusions: Obese men are more likely to have a higher PSA nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.",
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AU - Ho, Tammy

AU - Gerber, Leah

AU - Aronson, William J.

AU - Terris, Martha Kennedy

AU - Presti, Joseph C.

AU - Kane, Christopher J.

AU - Amling, Christopher L.

AU - Freedland, Stephen J.

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AB - Background: Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. Objective: To examine whether obesity predicts higher prostate-specific antigen (PSA) nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. Design, setting, and participants: A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration-based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. Intervention: All patients underwent RP. Outcome measurements and statistical analysis: We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA nadir. Results and limitations: Mean BMI was 28.5 kg/m2. Higher BMI was associated with higher PSA nadir on both univariable (p = 0.001) and multivariable analyses (p < 0.001). Increased BMI was associated with increased BCR risk (hazard ratio [HR]: 1.06; p = 0.007). Adjusting for PSA nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p = 0.043). When stratified by PSA nadir, obesity only significantly predicted BCR in men with an undetectable nadir (p = 0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Conclusions: Obese men are more likely to have a higher PSA nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.

KW - Biochemical recurrence

KW - Obesity

KW - PSA nadir

KW - Prostate cancer

KW - Radical prostatectomy

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