TY - JOUR
T1 - Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy
T2 - Biology or Technique? Results from the SEARCH database
AU - Ho, Tammy
AU - Gerber, Leah
AU - Aronson, William J.
AU - Terris, Martha K.
AU - Presti, Joseph C.
AU - Kane, Christopher J.
AU - Amling, Christopher L.
AU - Freedland, Stephen J.
N1 - Funding Information:
Funding/Support and role of the sponsor: This study was supported by the US Department of Veterans Affairs, US Department of Defense Prostate Cancer Research Program, the American Urological Association Foundation/Astellas Rising Star in Urology Award, National Institutes of Health Specialized Programs of Research Excellence Grant P50 CA58236, the Georgia Cancer Coalition, National Institutes of Health R01CA100938, and National Institutes of Health Specialized Programs of Research Excellence Grant P50 CA92131-01A1. Views and opinions of, and endorsements by the author(s) do not reflect those of the US Army or the Department of Defense.
PY - 2012/11
Y1 - 2012/11
N2 - 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.
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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U2 - 10.1016/j.eururo.2012.08.015
DO - 10.1016/j.eururo.2012.08.015
M3 - Article
C2 - 22921964
AN - SCOPUS:84867069646
SN - 0302-2838
VL - 62
SP - 910
EP - 916
JO - European urology
JF - European urology
IS - 5
ER -
