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Langlais CS, Graff RE, Van Blarigan EL, Neuhaus JM, Cowan JE, Broering JM, Carroll P, Kenfield SA, Chan JM. Post-diagnostic health behaviour scores and risk of prostate cancer progression and mortality. Br J Cancer 2023; 129:346-355. [PMID: 37217583 PMCID: PMC10338438 DOI: 10.1038/s41416-023-02283-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Individual behaviours are associated with prostate cancer (PC) progression. Behavioural scores, comprised of multiple risk factors, allow assessment of the combined impact of multiple behaviours. METHODS We examined the association between six a priori scores and risk of PC progression and mortality among 2156 men with PC in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) cohort: two scores developed based on the PC survivorship literature ('2021 Score [+ Diet]'); a score developed based on pre-diagnostic PC literature ('2015 Score'); and three scores based on US recommendations for cancer prevention ('WCRF/AICR Score') and survival ('ACS Score [+ Alcohol]'). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for progression and PC mortality via parametric survival models (interval censoring) and Cox models, respectively. RESULTS Over a median (IQR) of 6.4 (1.3, 13.7) years, we observed 192 progression and 73 PC mortality events. Higher (i.e., healthier) 2021 Score + Diet and WCRF/AICR Scores were inversely associated with risk of PC progression (2021 + Diet: HRcontinuous = 0.76, 95% CI: 0.63-0.90. WCRF/AICR HRcontinuous = 0.83, 95% CI: 0.67-1.02) and mortality (2021 + Diet: HRcontinuous = 0.65, 95% CI: 0.45-0.93. WCRF/AICR HRcontinuous = 0.71; 95% CI: 0.57-0.89). The ACS Score + Alcohol was only associated with progression (HRcontinuous = 0.89, 95% CI: 0.81-0.98) while the 2021 Score was only associated with PC mortality (HRcontinuous = 0.62, 95% CI: 0.45-0.85). The 2015 was not associated with PC progression or mortality. CONCLUSION Findings strengthen the evidence that behavioural modifications following a prostate cancer diagnosis may improve clinical outcomes.
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Affiliation(s)
- Crystal S Langlais
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
- IQVIA, Durham, NC, USA.
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - John M Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Janet E Cowan
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Jeanette M Broering
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Peter Carroll
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Stacey A Kenfield
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - June M Chan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
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Post-diagnostic health behaviour scores in relation to fatal prostate cancer. Br J Cancer 2022; 127:1670-1679. [PMID: 36028533 PMCID: PMC9596495 DOI: 10.1038/s41416-022-01948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Individual health behaviours have been associated with fatal prostate cancer (PCa). Their combined association with fatal PCa after diagnosis is unknown. METHODS This prospective cohort included 4518 men diagnosed with nonmetastatic PCa from the Health Professionals Follow-up Study. Exposures included a three-factor score integrating post-diagnostic fatal PCa risk factors ("2021 PCa Behaviour Score"), six-factor score integrating incident aggressive PCa risk factors ("2015 PCa Behaviour Score"), and two scores integrating recommendations for cancer prevention and survival, respectively. Multivariable Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for fatal PCa. RESULTS Over a median 10.2 years, we observed 219 PCa deaths. Each additional point of one of the PCa-specific health behaviour scores (2015 PCa Behaviour Score) was associated with a 19% reduced fatal PCa risk (HR: 0.81, 95%CI: 0.68-0.97). The 2021 PCa Behaviour Score and scores integrating national recommendations were not associated with fatal PCa. CONCLUSIONS While a PCa-specific health behaviour score was associated with a reduced risk of fatal PCa, we did not otherwise observe strong evidence of associations between post-diagnostic scores and fatal PCa. Avoiding tobacco, healthy body size, and physical activity may decrease PCa death risk, but further research is needed to inform cancer survivorship recommendations.
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Kim WT, Kang HW, Seo SP, Kim YJ, Lee SC, Kim WJ, Cho BS, Ha YS, Kwon TG, Park J, Park SC, Jeong YB, Kang TW, Park SW, Yun SJ. Effect of pre-operative internal obturator muscle mass index in MRI on biochemical recurrence of prostate cancer patients after radical prostatectomy: a multi-center study. BMC Urol 2021; 21:85. [PMID: 34039340 PMCID: PMC8157456 DOI: 10.1186/s12894-021-00853-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/19/2021] [Indexed: 01/06/2023] Open
Abstract
Background Recent reports show that the pre-operative or post-operative skeletal mass index (sarcopenia) affects survival rates for various cancers; however, the link between prostate cancer survival and sarcopenia is unclear. Therefore, this study examined the effect of the pre-operative internal obturator muscle (IOM) mass index on biochemical recurrence (BCR) of prostate cancer (PCa) patients who underwent radical prostatectomy. Methods In total, 222 patients, who underwent open, laparoscopic, or robot-assisted radical prostatectomy at seven centers in 2011 and were followed up for 5 years, were enrolled. BCR was examined in the context of pre-operative IOM mass index and BMI. Results The mean age of the patients was 67.82 ± 6.23 years, and the mean pre-operative prostate-specific antigen (PSA) level was 11.61 ± 13.22 ng/ml. There was no significant difference in baseline characteristics between the low and high IOM mass index groups (p > 0.05). Age, pre-op PSA level, ECE, and T-stage were associated with BCR (p = 0.049, p < 0.001, p = 0.001, p = 0.004, respectively). BMI, prostate volume, Gleason score, resection margin, N-stage, M-stage and IOM mass index was not associated with BCR (p > 0.05). Conclusions Pre-operative IOM mass index was not associated with BCR; however, long-term follow-up is necessary to evaluate cancer-specific and overall survival of PCa patients.
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Affiliation(s)
- Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, 62, Kaeshin-dong, Heungduk-ku, Cheongju, Chungbuk, 361-711, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Ho Won Kang
- Department of Urology, College of Medicine, Chungbuk National University, 62, Kaeshin-dong, Heungduk-ku, Cheongju, Chungbuk, 361-711, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sung Pil Seo
- Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Yong-June Kim
- Department of Urology, College of Medicine, Chungbuk National University, 62, Kaeshin-dong, Heungduk-ku, Cheongju, Chungbuk, 361-711, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Sang Cheol Lee
- Department of Urology, College of Medicine, Chungbuk National University, 62, Kaeshin-dong, Heungduk-ku, Cheongju, Chungbuk, 361-711, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, 62, Kaeshin-dong, Heungduk-ku, Cheongju, Chungbuk, 361-711, South Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Bum Sang Cho
- Department of Radiology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Yun Sok Ha
- Department of Urology, College of Medicine, Kyungpook National University, Daegu, South Korea
| | - Tae Gyun Kwon
- Department of Urology, College of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jinsung Park
- Department of Urology, College of Medicine, Eulji University, Daejeon, South Korea
| | - Seung Chol Park
- Department of Urology, College of Medicine, Won Kang University, Iksan, South Korea
| | - Young Beom Jeong
- Department of Urology, College of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Taek Won Kang
- Department of Urology, College of Medicine, Jeonnam National University, Kwangju, South Korea
| | - Sung-Woo Park
- Department of Urology, College of Medicine, Pusan National University, Pusan, South Korea
| | - Seok Joong Yun
- Department of Urology, College of Medicine, Chungbuk National University, 62, Kaeshin-dong, Heungduk-ku, Cheongju, Chungbuk, 361-711, South Korea. .,Department of Urology, Chungbuk National University Hospital, Cheongju, South Korea.
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Langlais CS, Graff RE, Van Blarigan EL, Palmer NR, Washington SL, Chan JM, Kenfield SA. Post-Diagnostic Dietary and Lifestyle Factors and Prostate Cancer Recurrence, Progression, and Mortality. Curr Oncol Rep 2021; 23:37. [PMID: 33689041 PMCID: PMC7946660 DOI: 10.1007/s11912-021-01017-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This study aimed to summarize evidence published between 1999 and June 2020 examining diet and lifestyle after prostate cancer (PC) diagnosis in relation to risk of biochemical recurrence, PC progression, and PC-specific mortality. RECENT FINDINGS Secondary prevention is an important research area in cancer survivorship. A growing number of studies have reported associations between post-diagnostic modifiable behaviors and risk of PC outcomes. Evidence on modifiable lifestyle factors and PC remains limited. Where multiple studies exist, findings are often mixed. However, studies consistently suggest that smoking and consumption of whole milk/high-fat dairy are associated with higher risk of PC recurrence and mortality. In addition, physical activity and ½ to 1 glass of red wine/day have been associated with lower risk of recurrence and PC-specific mortality. Greater inclusion of racially/ethnically diverse groups in future research is necessary to understand these relationships in populations most impacted by adverse PC outcomes.
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Affiliation(s)
- Crystal S Langlais
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA.
| | - Rebecca E Graff
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Erin L Van Blarigan
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Nynikka R Palmer
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Samuel L Washington
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - June M Chan
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Stacey A Kenfield
- Department of Epidemiology & Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
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Frugé AD, Smith KS, Bail JR, Rais-Bahrami S, Demark-Wahnefried W. Biomarkers Associated With Tumor Ki67 and Cathepsin L Gene Expression in Prostate Cancer Patients Participating in a Presurgical Weight Loss Trial. Front Oncol 2020; 10:544201. [PMID: 33042834 PMCID: PMC7527501 DOI: 10.3389/fonc.2020.544201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022] Open
Abstract
Our previous presurgical weight loss trial among 40 prostate cancer patients found that rapid (but not slow) weight loss resulted in increased tumor Ki67 and Cathepsin L (CTSL) gene expression. In follow-up analyses, we strove to better understand these unexpected findings. A correlative study was undertaken by performing additional analyses [free fatty acids (FFAs), plasma CTSL, and inflammatory cytokines] on remaining pre-post intervention sera and exploring associations with extant data on tumor Ki67, body composition, physical activity (PA), and fecal microbiota. Positive associations were observed between changes in % body fat and FFAs (ρ = 0.428, p = 0.026), insulin (ρ = 0.432, p = 0.019), and Interleukin-6 (ρ = 0.411, p = 0.041). Change in Ki67 was inversely associated with change in lean mass (ρ = -0.912, p = 0.001) and change in insulin (ρ = -0.650, p = 0.042). Change in insulin was also associated with CTSL (ρ = -0.643, p = 0.024) and FFAs (ρ = -0.700, p = 0.016). Relative abundance of Bifidobacterium was associated with CTSL (ρ = 0.627, p = 0.039) and FFAs (ρ = 0.691, p = 0.019); Firmicutes was positively associated with change in PA (ρ = 0.830, p = 0.003). Contrary to hypotheses, FFAs decreased with systemic fat loss. Moreover, although glucose metabolism improved, it was inversely associated with Ki67 and CTSL. Lean mass loss was highly correlated with increased Ki67. The relationships between prostate tumor Ki67 and CTSL and weight loss associated changes in FFAs, lean mass, and fecal microbiota warrant further investigation.
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Affiliation(s)
- Andrew D. Frugé
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, AL, United States
| | - Kristen S. Smith
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, AL, United States
| | - Jennifer R. Bail
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
- O’Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
- O’Neal Comprehensive Cancer Center at UAB, University of Alabama at Birmingham, Birmingham, AL, United States
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Mason RJ, Boorjian SA, Bhindi B, Rangel L, Frank I, Karnes RJ, Tollefson MK. Examining the association between adiposity and biochemical recurrence after radical prostatectomy. Can Urol Assoc J 2018; 12:E331-E337. [PMID: 29603915 DOI: 10.5489/cuaj.4923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Herein, we examined the association between adiposity, as measured by computed tomography (CT), and biochemical recurrence (BCR) after radical prostatectomy (RP). METHODS Using axial CT images, preoperative fat mass index (FMI) was calculated for 698 men who underwent RP from 2007-2010 by using measurements of total surface area of adipose tissue at the L3 level. Obesity was classified according to National Health and Nutrition Examination Survey (NHANES) standards for obesity (FMI >9 kg/m2). The associations between obesity and the distribution of adiposity (visceral vs. subcutaneous) with BCR were examined using the Kaplan-Meier method and Cox proportional hazards regression analyses. RESULTS Obese men were older than non-obese men (63.0 vs. 60.7 years; p<0.001), but were similar with regards to all other clinical and pathological characteristics. With a median followup of six years, 152 patients were diagnosed with BCR. Five-year BCR-free survival was similar between obese and non-obese patients (80.6% vs. 82.1%; p=0.27). Furthermore, in multivariable analyses, obesity was not independently associated with the risk of BCR (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.73-1.43). Similar results were obtained when analyzing FMI as a continuous variable (HR 1.02; 95% CI 0.94-1.09 for each 1 kg/m2 increase in FMI). Additionally, neither visceral adiposity, subcutaneous adiposity, or visceral-to-subcutaneous adiposity ratio were associated with BCR (all p>0.05) in multivariable analyses. CONCLUSIONS Neither total abdominal adiposity nor the distribution of adiposity were independently associated with BCR after RP in this study. As such, the presence of obesity may not be a marker of increased oncological risk after RP.
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Affiliation(s)
- Ross J Mason
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | | | - Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | - Laureano Rangel
- Department of Health Science Research, Mayo Clinic, Rochester, MN, United States
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, United States
| | - R Jeffrey Karnes
- Department of Urology, Mayo Clinic, Rochester, MN, United States
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Obesity paradox in prostate cancer: increased body mass index was associated with decreased risk of metastases after surgery in 13,667 patients. World J Urol 2018; 36:1067-1072. [DOI: 10.1007/s00345-018-2240-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/16/2018] [Indexed: 12/21/2022] Open
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Mason RJ, Boorjian SA, Bhindi B, Rangel L, Frank I, Karnes RJ, Tollefson MK. The Association Between Sarcopenia and Oncologic Outcomes After Radical Prostatectomy. Clin Genitourin Cancer 2017; 16:e629-e636. [PMID: 29289518 DOI: 10.1016/j.clgc.2017.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/06/2017] [Accepted: 11/27/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Sarcopenia is associated with inferior perioperative and oncologic outcomes in patients undergoing surgery for multiple malignancies. The purpose of this study was to evaluate the association between sarcopenia and outcomes after radical prostatectomy (RP) for men with prostate cancer. PATIENTS AND METHODS Using a representative computed tomographic image from the L3 level, preoperative skeletal muscle indices (SMI) calculated for 698 patients who underwent RP between 2007 and 2010. Patients were classified as sarcopenic if they had a SMI < 55 cm2/kg2 according to international consensus. The associations between sarcopenia and biochemical recurrence (BCR), systemic progression (SP), and all-cause mortality (ACM) were investigated by Cox proportional hazards regression. RESULTS Sarcopenic patients were older than nonsarcopenic patients (mean age, 63.0 vs. 60.4 years, P < .001) but were otherwise similar with regard to clinical and pathologic characteristics. There was no significant difference in the perioperative complication rate after RP between sarcopenic and nonsarcopenic patients (16.5% vs. 17.4%, P = .82). At a median follow-up after surgery of 6.0 years, 152 patients were diagnosed with BCR, patients were diagnosed with SP, and 50 patients died. In multivariable analysis, the presence of sarcopenia was not significantly associated with the risks of BCR, SP, or ACM. Similar results were obtained when analyzing SMI as a continuous variable. CONCLUSION Sarcopenia was not found to be independently associated with perioperative complications or oncologic outcomes after RP. As such, the presence of sarcopenia may not be prognostic marker for inferior outcomes among men with localized prostate cancer undergoing RP.
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Affiliation(s)
- Ross J Mason
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Laureano Rangel
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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Maj-Hes AB, Mathieu R, Özsoy M, Soria F, Moschini M, Abufaraj M, Briganti A, Roupret M, Karakiewicz PI, Klatte T, Shariat SF. Obesity is associated with biochemical recurrence after radical prostatectomy: A multi-institutional extended validation study. Urol Oncol 2017; 35:460.e1-460.e8. [DOI: 10.1016/j.urolonc.2017.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 01/06/2023]
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Demark-Wahnefried W, Nix JW, Hunter GR, Rais-Bahrami S, Desmond RA, Chacko B, Morrow CD, Azrad M, Frugé AD, Tsuruta Y, Ptacek T, Tully SA, Segal R, Grizzle WE. Feasibility outcomes of a presurgical randomized controlled trial exploring the impact of caloric restriction and increased physical activity versus a wait-list control on tumor characteristics and circulating biomarkers in men electing prostatectomy for prostate cancer. BMC Cancer 2016; 16:61. [PMID: 26850040 PMCID: PMC4743419 DOI: 10.1186/s12885-016-2075-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/19/2016] [Indexed: 01/10/2023] Open
Abstract
Background Obesity is associated with tumor aggressiveness and disease-specific mortality for more than 15 defined malignancies, including prostate cancer. Preclinical studies suggest that weight loss from caloric restriction and increased physical activity may suppress hormonal, energy-sensing, and inflammatory factors that drive neoplastic progression; however, exact mechanisms are yet to be determined, and experiments in humans are limited. Methods We conducted a randomized controlled trial among 40 overweight or obese, newly-diagnosed prostate cancer patients who elected prostatectomy to explore feasibility of a presurgical weight loss intervention that promoted a weight loss of roughly one kg. week−1 via caloric restriction and physical activity, as well as to assess effects on tumor biology and circulating biomarkers. Measures of feasibility (accrual, retention, adherence, and safety) were primary endpoints. Exploratory aims were directed at the intervention’s effect on tumor proliferation (Ki-67) and other tumor markers (activated caspase-3, insulin and androgen receptors, VEGF, TNFβ, NFκB, and 4E-BP1), circulating biomarkers (PSA, insulin, glucose, VEGF, TNFβ, leptin, SHBG, and testosterone), lymphocytic gene expression of corresponding factors and cellular bioenergetics in neutrophils, and effects on the gut microbiome. Consenting patients were randomized in a 1:1 ratio to either: 1) weight loss via a healthful, guidelines-based diet and exercise regimen; or 2) a wait-list control. While biological testing is currently ongoing, this paper details our methods and feasibility outcomes. Results The accrual target was met after screening 101 cases (enrollment rate: 39.6 %). Other outcomes included a retention rate of 85 %, excellent adherence (95 %), and no serious reported adverse events. No significant differences by age, race, or weight status were noted between enrollees vs. non-enrollees. The most common reasons for non-participation were “too busy” (30 %), medical exclusions (21 %), and “distance” (16 %). Conclusions Presurgical trials offer a means to study the impact of diet and exercise interventions directly on tumor tissue, and other host factors that are feasible and safe, though modifications are needed to conduct trials within an abbreviated period of time and via distance medicine-based approaches. Pre-surgical trials are critical to elucidate the impact of lifestyle interventions on specific mechanisms that mediate carcinogenesis and which can be used subsequently as therapeutic targets. Trial registration NCT01886677
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Affiliation(s)
- Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA.
| | | | - Gary R Hunter
- Department of Human Studies, UAB, Birmingham, AL, USA
| | | | | | - Balu Chacko
- Department of Molecular & Cellular Pathology, UAB, Birmingham, AL, USA
| | - Casey D Morrow
- Department of Cell, Developmental & Integrative Biology, UAB, Birmingham, AL, USA
| | - Maria Azrad
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA
| | - Andrew D Frugé
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA
| | - Yuko Tsuruta
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 346 Webb Nutrition Sciences Bldg., 1675 University Blvd, Birmingham, AL, USA
| | - Travis Ptacek
- Department of Microbiology, UAB, Birmingham, AL, USA
| | | | - Roanne Segal
- Department of Medicine, University of Ottawa, Ontario, Canada
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Narita S, Mitsuzuka K, Tsuchiya N, Koie T, Kawamura S, Ohyama C, Tochigi T, Yamaguchi T, Arai Y, Habuchi T. Reassessment of the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer treated using radical prostatectomy. Int J Urol 2015; 22:1029-35. [DOI: 10.1111/iju.12898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Shintaro Narita
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Koji Mitsuzuka
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Norihiko Tsuchiya
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Takuya Koie
- Department of Urology; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | | | - Chikara Ohyama
- Department of Urology; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Tatsuo Tochigi
- Department of Urology; Miyagi Cancer Center; Natori Japan
| | - Takuhiro Yamaguchi
- Department of Medical Sciences and Biostatistics; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yoichi Arai
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Tomonori Habuchi
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
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Mohammed AA, El-Tanni H, Ghanem HM, Farooq MU, El Saify AM, Al-Zahrani AS, El-Shentenawy A, El-Khatib HM. Impact of body mass index on clinico-pathological parameters and outcome in patients with metastatic prostate cancer. J Egypt Natl Canc Inst 2015; 27:155-9. [PMID: 26227217 DOI: 10.1016/j.jnci.2015.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study evaluates the correlation between body mass index (BMI) and clinicopathological parameters of metastatic prostate cancer (MPC) and its impact on survival. METHOD During the study period, 71 MPC patients were eligible. Patients with BMI<25.0kg/m(2) were categorized as level I and patients with BMI⩾25.0kg/m(2) were categorized as level II. Demographic features and survival rates were evaluated by the Kaplan-Meier method and Cox proportional models. RESULTS 31 patients belonged to level I while the rest belonged to level II with insignificant higher median follow-up duration in level II; p=0.5. In terms of age, metastasis, serum level of albumin, prostatic specific antigen, alkaline phosphatase (AKP) and Gleason score, there was no significant difference between the two levels. The cumulative survival probability in the 12th, 24th and 36th month in level I vs; level II was; 86.7%, 68.7%, 64.1% vs; 74.4%, 67.7%, 55.1%, respectively with 7 patients dead in level I compared to 14 patients dead in level II denoting a higher PC-specific death rate in the level II group. In univariate and multivariate analysis, poor prognosis was associated with increasing AKP (HR=1.0005, 95% CI, p=0.03; HR=1.001, 95% CI, p=0.03) respectively, while better prognosis was associated with no visceral metastasis (HR=0.09, 95% CI, p=0.000; HR=0.04, 95% CI, p=0.000) and increasing albumin levels (HR=0.17, 95% CI, p=0.000; HR=0.15, 95% CI, p=0.000) respectively. In multivariate analysis only, patients belonging to level I were associated with better prognosis (HR=0.17, 95% CI, p=0.02). CONCLUSION BMI is dependent on prognostic factors in patients with MPC.
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Affiliation(s)
- Amrallah A Mohammed
- Oncology Center, King Abdullah Medical City-Holy Capital, Saudi Arabia; Medical Oncology Department, Faculty of Medicine, Zagazig University, Egypt.
| | - Hani El-Tanni
- Oncology Center, King Abdullah Medical City-Holy Capital, Saudi Arabia
| | - Hafez M Ghanem
- Oncology Center, King Abdullah Medical City-Holy Capital, Saudi Arabia
| | - Mian U Farooq
- Strategic Planning Department, King Abdullah Medical City-Holy Capital, Saudi Arabia
| | - Amr M El Saify
- Oncology Center, King Abdullah Medical City-Holy Capital, Saudi Arabia
| | | | | | - Hani M El-Khatib
- Oncology Center, King Abdullah Medical City-Holy Capital, Saudi Arabia
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13
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Effets de l’obesité sur les résultats anatomopathologiques de la prostatectomie totale et sur la survie sans recidive biologique. Prog Urol 2015; 25:420-7. [PMID: 25891781 DOI: 10.1016/j.purol.2015.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 03/01/2015] [Accepted: 03/14/2015] [Indexed: 12/19/2022]
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14
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Michl U, Molfenter F, Graefen M, Tennstedt P, Ahyai S, Beyer B, Budäus L, Haese A, Heinzer H, Oh SJ, Salomon G, Schlomm T, Steuber T, Thederan I, Huland H, Tilki D. Use of Phosphodiesterase Type 5 Inhibitors May Adversely Impact Biochemical Recurrence after Radical Prostatectomy. J Urol 2015; 193:479-83. [DOI: 10.1016/j.juro.2014.08.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Uwe Michl
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Frederike Molfenter
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre Tennstedt
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Ahyai
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Burkhard Beyer
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Su Jung Oh
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schlomm
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Imke Thederan
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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15
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Chalfin HJ, Lee SB, Jeong BC, Freedland SJ, Alai H, Feng Z, Trock BJ, Partin AW, Humphreys E, Walsh PC, Han M. Obesity and Long-Term Survival after Radical Prostatectomy. J Urol 2014; 192:1100-4. [DOI: 10.1016/j.juro.2014.04.086] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Heather J. Chalfin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Seung Bae Lee
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Byong Chang Jeong
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Stephen J. Freedland
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Hamid Alai
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Zhaoyong Feng
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Bruce J. Trock
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Alan W. Partin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Elizabeth Humphreys
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Patrick C. Walsh
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
| | - Misop Han
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Seoul National University Boramae Hospital (SBL), Seoul, South Korea
- Sungkyunkwan University Samsung Medical Center (BCJ), Seoul, South Korea
- Duke University Medical Center, Durham, North Carolina (SJF)
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Gözen AS, Akin Y, Özden E, Ates M, Hruza M, Rassweiler J. Impact of body mass index on outcomes of laparoscopic radical prostatectomy with long-term follow-up. Scand J Urol 2014; 49:70-6. [PMID: 25130508 DOI: 10.3109/21681805.2014.920416] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of body mass index (BMI) on the functional and oncological results of patients who had undergone laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS In total, 1224 patients with follow-up data (>24 months) were enrolled. Patients were divided into three groups according to BMI (kg/m(2)) as: group 1 (normal, BMI <25, n = 425), group 2 (overweight, 25 ≤ BMI <30, n = 594) and group 3 (obese, BMI ≥ 30, n = 205). Demographic, intraoperative and postoperative data with oncological outcomes were recorded. The impact of obesity on those parameters was evaluated and statistical analyses were performed. RESULTS Mean age was 63.8 ± 6.1 years and mean follow-up was 43.1 ± 25.1 months (mean ± SD). There were 425 (34.7%) patients in group 1, 594 (48.5%) in group 2 and 205 (16.8%) in group 3. Operation time, clinical stage and estimated blood loss were significantly higher in group 3 than in the other groups (p < 0.001, p = 0.001 and p = 0.001, respectively). Bilateral nerve-sparing rate and bladder neck-sparing rate were significantly decreased in group 3 compared with the other groups (p = 0.001 and p < 0.038, respectively). Statistically significantly higher pathological stage, tumour volume, positive surgical margin and Gleason scores were determined in group 3 compared with the other groups (p = 0.023, p = 0.018, p = 0.009 and p = 0.028, respectively). There were similar urinary continence rates among the groups. The rate of penetration with or without medication was significantly lower in group 3 than in the other groups (p = 0.593 and p = 0.007, respectively). CONCLUSIONS LRP seemed safe and effective in obese patients, with similar mean overall survival, cancer-specific survival, complication rates and continence rates to normal weight patients in the long term.
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Affiliation(s)
- Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg , Heilbronn , Germany
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17
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Busch J, Gonzalgo ML, Leva N, Ferrari M, Cash H, Kempkensteffen C, Hinz S, Miller K, Magheli A. Matched comparison of robot‐assisted, laparoscopic and open radical prostatectomy regarding pathologic and oncologic outcomes in obese patients. World J Urol 2014; 33:397-402. [DOI: 10.1007/s00345-014-1326-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/12/2014] [Indexed: 12/28/2022] Open
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18
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Choi WM, Lee JH, Yoon JH, Kwak C, Lee YJ, Cho YY, Lee YB, Yu SJ, Kim YJ, Kim HH, Kim HC, Cho SY, Lee SB, Jeong H, Kim CY, Lee HS. Nonalcoholic fatty liver disease is a negative risk factor for prostate cancer recurrence. Endocr Relat Cancer 2014; 21:343-53. [PMID: 24481324 DOI: 10.1530/erc-14-0036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is closely related to the metabolic syndrome, which is associated with an increased risk of various malignancies. In this study, we investigated the association between NAFLD and prostate cancer biochemical recurrence (BCR) after radical prostatectomy. Consecutive prostate cancer patients who underwent radical prostatectomy were enrolled from two hospitals in Korea and randomly assigned to the training (n=147) or validation set (n=146). The presence of NAFLD, BMI, preoperative prostate-specific antigen, and histological findings including Gleason score (GSc) were analyzed in regard to their association with BCR. NAFLD was diagnosed based on ultrasonography or unenhanced computed tomography images. BCR-free survival rates were calculated using the Kaplan-Meier method. In the training set, 32 (21.8%) patients developed BCR during a median follow-up period of 51 (inter-quartile range, 35-65) months. In the multivariate analysis, the presence of NAFLD (hazard ratio (HR), 0.36; 95% CI, 0.14-0.97; P=0.04) was an independent negative predictive factor of BCR after adjustment for pathological GSc. Applied to the validation set, the presence of NAFLD maintained its prognostic value for longer time-to-BCR (HR, 0.17; 95% CI, 0.06-0.49; P=0.001). In the subgroup analysis of patients with NAFLD, NAFLD fibrosis score was a single independent negative predictor for BCR (HR, 0.54; 95% CI, 0.30-0.98; P=0.04). Our study demonstrated that NAFLD may play a protective role against BCR after radical prostatectomy for prostate cancer. Further study is warranted to elucidate the mechanism of protective effect in patients with NAFLD.
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Affiliation(s)
- Won-Mook Choi
- Departments of Internal Medicine and Liver Research Institute Urology Radiology, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Republic of Korea Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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Obesity has multifaceted impact on biochemical recurrence of prostate cancer: a dose-response meta-analysis of 36,927 patients. Med Oncol 2014; 31:829. [PMID: 24390417 DOI: 10.1007/s12032-013-0829-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/23/2013] [Indexed: 12/26/2022]
Abstract
Obesity is inconsistently related to biochemical recurrence (BCR) of prostate cancer (PCa) in different epidemiological studies. We conducted a systematic review and dose-response meta-analysis of published studies from MEDLINE and EMBASE in order to determine the relationship between body mass index (BMI) and BCR of PCa. We identified a total of 26 studies including 36,927 individuals. Pooled estimates of relative risk (RR) and confidence interval (CI) were computed, and dose-response meta-analysis was subsequently performed. Based on the random-effects approach, a 5 kg/m(2) increase in BMI was associated with 16 % (RR 1.16, 95 % CI 1.08-1.24) higher risk of BCR for entire set of 26 studies. Significantly higher rates of BCR were also observed in radical prostatectomy series (RR 1.17, 95 % CI 1.07-1.28) and external beam radiation therapy series (RR 1.19, 95 % CI 1.10-1.28), while no significant correlation was observed in brachytherapy series (RR 0.91, 95 % CI 0.64-1.28). Different BCR outcomes came out for studies held in USA (RR 1.18, 95 % CI 1.10-1.28), Europe (RR 1.04 95 % CI 0.91-1.17) and Asia (RR 1.83 95 % CI 0.85-3.97), respectively. There was limited evidence of a nonlinear association between BMI and BCR, which showed a critical point of 33 in BMI. The findings from meta-analysis showed that excess BMI was positively correlated with BCR of PCa multifacetedly, indicating good weight control and detailed attention to treating obese patients might improve the prognosis of PCa.
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20
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The effect of BMI on clinicopathologic and functional outcomes after open radical prostatectomy. Urol Oncol 2013; 32:297-302. [PMID: 24332640 DOI: 10.1016/j.urolonc.2013.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/10/2013] [Accepted: 09/01/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To analyze the effect of body mass index (BMI) on pathologic and functional outcomes after open radical retropubic prostatectomy. PATIENTS AND METHODS We retrospectively analyzed 2,471 patients who underwent RP. Clinicopathologic and patient characteristics were compared with respect to patients' BMI (normal weight: BMI < 25 kg/m(2) [n = 795], overweight: BMI ≥ 25 kg/m(2) and < 30 kg/m(2) [n = 1305], and obese: BMI ≥ 30 kg/m(2) [n = 371]). Multivariable logistic and linear regression models were used to quantify the effect of BMI on pathologic and functional outcomes. RESULTS Compared with normal weight patients, overweight and obese patients demonstrated higher pathologic Gleason grade and higher pathologic T stage, without any difference in preoperative prostate-specific antigen levels. Overweight and obese men were less likely to have a negative surgical margin (odds ratio (OR) 0.74 [confidence interval (CI) 0.65-0.84, P<0.001] for overweight men and OR 0.66 [CI 0.49-0.89, P<0.01] for obese men) and had a lower rate of postoperative erectile function (OR 0.60 [CI 0.48-0.76, P<0.001] for overweight patients and OR 0.34 [CI 0.27-0.44, P<0.001] for obese patients). Moreover, duration of surgery and intraoperative blood loss increased significantly with an increase in BMI. When using BMI as a continuous variable, the same trends were demonstrated. However, a lower rate of continence was not evident for overweight or obese men. CONCLUSIONS In contrast to many other studies, in this cohort of patients with prostate cancer, BMI was an independent risk factor for most analyzed pathologic and functional outcomes after radical prostatectomy, including negative surgical margin, potency, duration of surgery, and intraoperative blood loss.
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Impact of body mass index on clinicopathological outcome and biochemical recurrence after radical prostatectomy. Prostate Cancer Prostatic Dis 2013; 16:271-6. [PMID: 23752230 DOI: 10.1038/pcan.2013.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/23/2013] [Accepted: 05/09/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accumulating evidence suggests that obesity is associated with tumor progression in prostate cancer (PCa) patients after radical prostatectomy (RP). We conducted a retrospective multicenter study to determine the effect of body mass index (BMI) on the clinicopathological characteristics and biochemical recurrence of PCa in Japanese men who underwent RP. METHODS The medical records of 1257 men with PCa treated by RP without neoadjuvant therapy at four medical institutes between 2001 and 2009 were retrospectively reviewed. Patients were categorized into four groups using the World Health Organization (WHO) BMI classification and BMI quartiles. Associations of the various BMI categories with clinicopathological characteristics and biochemical recurrences were statistically evaluated. Biochemical recurrence was defined as a PSA level of >0.2 ng ml(-1). RESULTS Of the 1257 patients, 230 (18.3%) experienced biochemical recurrence during the median follow-up period of 49 months. The median BMI was 23.8 kg m(-2), and 1.4% patients were underweight, 65.4% were of normal weight, 30.9% were overweight and 2.4% were obese (WHO classification). Preoperative PSA levels and PSA density (PSAD) tended to decrease as BMI increased. Pathological characteristics did not differ significantly among BMI categories. As per the WHO classification and quartile categories, biochemical recurrence rate was comparable among the BMI groups. After adjusting for other pre- and postoperative covariables, multivariate Cox proportional hazards analysis revealed that a high BMI did not have an independent impact on biochemical recurrence-free survival. CONCLUSIONS Underweight Japanese PCa patients treated by RP had higher preoperative PSA levels and PSAD. High BMI was not associated with adverse pathological findings or increased biochemical recurrence rate in Japanese PCa patients treated with RP. Racial differences may exist in the relationship between obesity and outcomes of RP in PCa patients.
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Tomaszewski JJ, Nelson JB. Reply. Urology 2013. [DOI: 10.1016/j.urology.2012.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tomaszewski JJ, Chen YF, Bertolet M, Ristau BT, Woldemichael E, Nelson JB. Obesity is not associated with aggressive pathologic features or biochemical recurrence after radical prostatectomy. Urology 2013; 81:992-6. [PMID: 23453649 DOI: 10.1016/j.urology.2012.10.080] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/17/2012] [Accepted: 10/20/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether obesity is associated with adverse pathologic characteristics, positive surgical margins, greater biochemical recurrence rates, and interval to death after primary treatment with radical prostatectomy (RP). MATERIALS AND METHODS A 12-year, retrospective, single-institution analysis of patients treated with RP was performed. Patients were categorized by their body mass index (BMI) as normal weight (n = 533), overweight (n = 1342), obese (n = 603), and morbidly obese (n = 22). The associations among the BMI, clinicopathologic characteristics, and biochemical recurrence rates were assessed. RESULTS After adjusting for multiple clinical preoperative characteristics, the BMI category was not associated with positive surgical margins (P = .66), organ-confined disease (P = .10), Gleason score (P = .22), extracapsular extension (P = .09), seminal vesicle invasion (P = .15), percentage of cancer in the prostate gland (P = .67), largest tumor nodule (P = .13), or lymph node metastasis (P = .39). Gleason score 4+3 (P <.001), Gleason score 9 and 10 (P <.001), and an increasing prostate-specific antigen level (P <.001) were associated with biochemical recurrence. At a mean overall follow-up of 55.6 months, 276 patients (11.0%) had developed biochemical recurrence (normal weight 11.3%, overweight 10.5%, obese 12.3%, and morbid obesity 4.5%). After multivariate adjustment for age, ethnicity, risk group, clinical stage, Gleason score, preoperative prostate-specific antigen level, and year of surgery, no association was found between the BMI and biochemical recurrence (P = .87). CONCLUSION In men undergoing RP for clinically localized prostate adenocarcinoma, obesity was not associated with adverse pathologic features, positive surgical margins, or biochemical recurrence. These data provide evidence that obese men undergoing RP are not more likely to have aggressive prostate cancer.
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Park JM, Nam JS, Na W, Oh JJ, Lee S, Hong SK, Byun SS, Lee SE. Prognostic value of body mass index in korean patients with castration-resistant prostate cancer. Korean J Urol 2012. [PMID: 23185667 PMCID: PMC3502734 DOI: 10.4111/kju.2012.53.11.761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose We investigated the correlation between body mass index (BMI) and the prognosis of castration-resistant prostate cancer (CRPC) in patients who received docetaxel treatment. Materials and Methods A retrospective study was conducted of 55 patients who were diagnosed with CRPC and received docetaxel treatment between 2003 and 2009 at our institution. Patients with a normal or lower BMI (<23.0 kg/m2) were categorized as group I and patients with an overweight or greater BMI (≥23.0 kg/m2) were categorized as group II. Clinicopathological features and survival rates were evaluated by using the Kaplan-Meier method and Cox proportional hazards models. Results On the basis of BMI, 27 patients (49.1%) belonged to group I and 28 (50.9%) patients belonged to group II. Mean follow-up periods were 30 months and 34.2 months, respectively (p=0.381). There were no significant differences between the two groups in terms of age, prostate-specific antigen (PSA), Gleason score, Eastern Cooperative Oncology Group Performance Status, hemoglobin level, alkaline phosphatase level, distant metastasis, radiation treatments, or performance of radical prostatectomy (p>0.05). In the univariate analysis for predicting survival rates, BMI (p=0.005; hazard ratio [HR], 0.121), logPSA (p=0.044; HR, 2.878), and alkaline phosphatase level (p=0.039; HR, 8.582) were significant factors for prediction. In the multivariate analysis, BMI (p=0.005; HR, 0.55), logPSA (p=0.008; HR, 7.836), Gleason score (p=0.018; HR, 6.434), hemoglobin (p=0.006; HR, 0.096), alkaline phosphatase level (p=0.005; HR, 114.1), and metastasis to the internal organs (p=0.028; HR, 5.195) were significant factors for prediction. Conclusions Better effects on the cancer-specific survival rate were observed in cases with higher BMI.
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Affiliation(s)
- Jeong Min Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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25
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Woodard G, Ahmed S, Podelski V, Hernandez-Boussard T, Presti J, Morton JM. Effect of Roux-en-Y gastric bypass on testosterone and prostate-specific antigen. Br J Surg 2012; 99:693-8. [DOI: 10.1002/bjs.8693] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2012] [Indexed: 01/30/2023]
Abstract
Abstract
Background
Obese men have lower serum levels of testosterone, dehydroepiandrosterone (DHEA) and prostate-specific antigen (PSA), but an increased risk of dying from prostate cancer. The aim of this study was to examine the effect of surgically induced weight loss on serum testosterone, DHEA and PSA levels in obese men.
Methods
Consecutive men undergoing Roux-en-Y gastric bypass (RYGB) participated in a prospective, longitudinal study. Main outcomes were changes were body mass index (BMI), percentage excess weight loss, serum levels of testosterone, DHEA and PSA, PSA mass and plasma volume, measured before operation and 3, 6 and 12 months later.
Results
In 64 patients, mean BMI fell from 48·2 kg/m2 before operation to 39·2, 35·6 and 32·4 kg/m2 at 3, 6 and 12 months after RYGB. Testosterone levels rose significantly from 259 ng/dl to 386, 452 and 520 ng/dl respectively. Serum PSA levels increased significantly from 0·51 ng/ml to 0·67 ng/ml at 12 months. There were no significant changes in DHEA or PSA mass.
Conclusion
RYGB normalizes the serum testosterone level. PSA levels increase with weight loss and may be inversely correlated with changes in plasma volume, indicating that PSA levels may be artificially low in obese men owing to haemodilution.
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Affiliation(s)
- G Woodard
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, California, USA
| | - S Ahmed
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, California, USA
| | - V Podelski
- Institut de Recherche Contre les Cancers de l'Appareil Digestif, Strasbourg, France
| | - T Hernandez-Boussard
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, California, USA
| | - J Presti
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - J M Morton
- Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, California, USA
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Badalato GM, Kates M, Wisnivesky JP, Choudhury AR, McKiernan JM. Survival after partial and radical nephrectomy for the treatment of stage T1bN0M0 renal cell carcinoma (RCC) in the USA: a propensity scoring approach. BJU Int 2011; 109:1457-62. [PMID: 21933334 DOI: 10.1111/j.1464-410x.2011.10597.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
UNLABELLED Study Type - Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Partial nephrectomy has become the standard of care for T1a renal tumours, and the application of nephron-sparing techniques has increasingly been expanded to patients with localized T1b cancers. However, the relative efficacy of partial versus radical nephrectomy for these medium-sized tumours has yet to be definitively established. This study employs a propensity scoring approach within a large US population-based cohort to determine that no survival differences exist among patients with T1b renal tumours undergoing partial versus radical nephrectomy. OBJECTIVES To compare survival after partial nephrectomy (PN) vs radical nephrectomy (RN) among patients with stage TIb renal cell carcinoma (RCC) using a propensity scoring approach. Propensity score analysis is a statistical methodology that controls for non-random assignment of patients in observational studies. PATIENTS AND METHODS Using the Surveillance, Epidemiology, and End Results registry, 11,256 cases of RCCs of 4-7 cm that underwent PN or RN between 1998 and 2007 were identified. Propensity score analysis was used to adjust for potential differences in baseline characteristics between patients in the two treatment groups. Overall survival (OS) and cancer-specific survival (CSS) of patients undergoing PN vs RN was compared in stratified and adjusted analysis, controlling for propensity scores. RESULTS In all, 1047 (9.3%) patients underwent PN. For the entire cohort, no difference in survival was found in patients treated with PN as compared with RN, as shown by the adjusted hazard ratio (HR) for OS (1.10; 95% confidence interval [CI]: 0.91-1.36) and renal-CSS (HR 0.91; 95% CI: 0.65-1.27). When the cohort was stratified by tumour size and age, no difference in survival was identified between the groups. CONCLUSIONS Even when stratified by tumour size and age, a survival difference between PN and RN in a propensity-adjusted cohort of patients with T1b RCC could not be confirmed. If validated in prospective studies, PN may become the preferred treatment for T1b renal tumours in centres experienced with nephron-sparing surgery.
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Affiliation(s)
- Gina M Badalato
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Chambers SK, Newton RU, Girgis A, Nielsen L, Lepore S, Mihalopoulos C, Gardiner R, Galvão DA, Occhipinti S. Living with prostate cancer: randomised controlled trial of a multimodal supportive care intervention for men with prostate cancer. BMC Cancer 2011; 11:317. [PMID: 21791109 PMCID: PMC3161036 DOI: 10.1186/1471-2407-11-317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 07/27/2011] [Indexed: 11/10/2022] Open
Abstract
Background Prostate cancer is the most common male cancer in developed countries and diagnosis and treatment carries with it substantial morbidity and related unmet supportive care needs. These difficulties may be amplified by physical inactivity and obesity. We propose to apply a multimodal intervention approach that targets both unmet supportive care needs and physical activity. Methods/design A two arm randomised controlled trial will compare usual care to a multimodal supportive care intervention "Living with Prostate Cancer" that will combine self-management with tele-based group peer support. A series of previously validated and reliable self-report measures will be administered to men at four time points: baseline/recruitment (when men are approximately 3-6 months post-diagnosis) and at 3, 6, and 12 months after recruitment and intervention commencement. Social constraints, social support, self-efficacy, group cohesion and therapeutic alliance will be included as potential moderators/mediators of intervention effect. Primary outcomes are unmet supportive care needs and physical activity levels. Secondary outcomes are domain-specific and health-related quality of life (QoL); psychological distress; benefit finding; body mass index and waist circumference. Disease variables (e.g. cancer grade, stage) will be assessed through medical and cancer registry records. An economic evaluation will be conducted alongside the randomised trial. Discussion This study will address a critical but as yet unanswered research question: to identify a population-based way to reduce unmet supportive care needs; promote regular physical activity; and improve disease-specific and health-related QoL for prostate cancer survivors. The study will also determine the cost-effectiveness of the intervention. Trial Registration ACTRN12611000392965
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Bittner N, Merrick GS, Stewart R, Andreini H, Taubenslag W, Curtis R, Butler WM, Wallner KE. Obesity does not correlate with adverse pathologic findings on transperineal template-guided mapping biopsy of the prostate. Urol Oncol 2011; 29:398-404. [DOI: 10.1016/j.urolonc.2009.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 11/27/2022]
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Lee DJ, Ritch C, Desai M, Benson MC, McKiernan JM. The interaction of body mass index and race in predicting biochemical failure after radical prostatectomy. BJU Int 2011; 107:1741-7. [PMID: 20942835 PMCID: PMC6361109 DOI: 10.1111/j.1464-410x.2010.09768.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
STUDY TYPE Therapy (case series). LEVEL OF EVIDENCE 4 OBJECTIVE To examine the interaction of body mass index (BMI) and race in predicting biochemical failure (BCF) after radical prostatectomy (RP). The relative contribution of BMI and race to BCF after RP has not been well characterized. PATIENTS AND METHODS From 1988 to 2008, 969 white and black men underwent RP and BMI data were available. In all, 168 (17.3%) were black and 801 (82.7%) were white men. BCF was defined as a post-surgery PSA level≥0.2 ng/mL on ≥2 measurements. Cox regression methods were used to model the relationship between race, BMI and BCF. RESULTS The 969 men had a mean age of 59.8±7.2 years. There was no significant difference in BMI between black and white men (P=0.32). The 5-year disease-free survival for black obese men was the lowest at 48%, compared with non-obese black (73%), obese white (82%) and non-obese white men (83%, P<0.001). BMI did not have a significant impact on BCF. In a multivariate analysis, black race remained an independent predictor of BCF [hazard ratio (HR)=1.76, P=0.01]. BMI does not affect the risk of BCF in black men differently than white men (P value for interaction 0.93). CONCLUSIONS Black race is an independent predictor of biochemical failure after adjusting for pathological factors. The impact of BMI on BCF did not vary among different races. These findings suggest that elevated BMI does not affect the BCF rates of black men more than in other races, and that other factors may influence the racial variability in disease-free survival and BCF risk.
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Affiliation(s)
- Daniel J Lee
- Department of Urology, Columbia University Medical Center, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
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Leptin increases prostate cancer aggressiveness. J Physiol Biochem 2011; 67:531-8. [PMID: 21559935 DOI: 10.1007/s13105-011-0098-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
Abstract
Recent studies indicate that adipose tissue and adipocytokines might affect the development of prostate cancer (PCa). Leptin would have a stimulating effect on prostate cancer cells by inducing promotion and progression, whereas adiponectin would have a protective effect. The aim of this study was to determine the relation between body composition, leptin, and adiponectin levels with the prevalence and aggressiveness of PCa in men of Mendoza, Argentina. Seventy volunteers between 50 and 80 years (35 healthy men as control group and 35 with PCa) were selected. The PCa group was subclassified according to the Gleason Score (GS). Digital rectal examination, transrectal ultrasound, and prostatic biopsy were performed; PSA, testosterone, leptin, and adiponectin levels were determined; and a nutritional interview including anthropometric measurements and a food frequency questionnaire was carried out. Statistical analysis was performed by Student t test, ANOVA I, and Bonferroni (p < 0.05). Body mass index and percentage of body fat mass were not statistically different between PCa and control groups. However, body fat mass was higher in subjects with more aggressive tumors (p = 0.032). No differences were observed regarding leptin levels between the groups. Nevertheless, leptin levels were higher in subjects with high GS (p < 0.001). Adiponectin levels showed no statistical differences regarding the presence and aggressiveness of the tumor (p = 0.131). Finally, consumption and nutrient intake did not differ in the studied groups. In conclusion, body composition and leptin are related to the PCa aggressiveness but not with its prevalence.
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Ritch CR, Hruby G, Badani KK, Benson MC, McKiernan JM. Effect of statin use on biochemical outcome following radical prostatectomy. BJU Int 2011; 108:E211-6. [PMID: 21453350 DOI: 10.1111/j.1464-410x.2011.10159.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE •To determine the relationship between statin use and biochemical recurrence (BCR) following radical prostatectomy (RP). PATIENTS AND METHODS •A retrospective analysis was performed on 3198 RP patients between 1990 and 2008. •Exclusion criteria were neo-adjuvant or adjuvant therapy, follow-up <2 years, and insufficient pathological or prostate-specific antigen (PSA) data. •Statin use was determined from the patient's record. Clinical and pathological variables were compared between statin users and non-users. •Kaplan-Meier and multivariate Cox regression analyses were performed to determine the effect of statin use on BCR. RESULTS •A total of 1261 patients fit criteria for analysis. There were 281 (22%) statin users. Mean age was 60 years and median follow-up was 36 months (mean 43 months). •Statin users had a lower median preoperative PSA (6.4) compared with non-users (7.1) (P < 0.05). In all, 80% of statin users had a pathological Gleason sum ≥7 compared with 67% of non-users (P < 0.05). •On multivariate analysis, statin use was an independent predictor of BCR (hazard ratio 1.54, P < 0.05). Statin users had a lower 5-year BCR-free survival compared with non-users (75% vs 84%, P < 0.05). CONCLUSIONS •Statin users are at an increased risk for BCR following RP. This finding may be due to the reduction in preoperative PSA potentially delaying diagnosis and/or masking aggressive disease. •Further studies are necessary to elucidate the impact of statin medications following prostate cancer therapy.
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Affiliation(s)
- Chad R Ritch
- Columbia University Medical Center/NY Presbyterian Hospital, Department of Urology, 161 Ft. Washington Ave, HIP 11, New York, NY 10032, USA.
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Joshu CE, Mondul AM, Menke A, Meinhold C, Han M, Humphreys EB, Freedland SJ, Walsh PC, Platz EA. Weight gain is associated with an increased risk of prostate cancer recurrence after prostatectomy in the PSA era. Cancer Prev Res (Phila) 2011; 4:544-51. [PMID: 21325564 DOI: 10.1158/1940-6207.capr-10-0257] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although obesity at the time of prostatectomy has been associated with prostate cancer recurrence, it is unknown whether obesity before or after surgery, or weight change from the years prior to surgery to after surgery is associated with recurrence. Thus, we examined the influence of obesity and weight change on recurrence after prostatectomy. We conducted a retrospective cohort study of 1,337 men with clinically localized prostate cancer who underwent prostatectomy performed during 1993-2006 by the same surgeon. Men self-reported weight and physical activity at 5 years before and 1 year after surgery on a survey during follow-up. Mean follow-up was 7.3 years. We estimated multivariable-adjusted HRs of prostate cancer recurrence comparing obesity at 5 years before and at 1 year after surgery with normal weight, and a gain of more than 2.2 kg from 5 years before to 1 year after surgery with stable weight. During 9,797 person years of follow-up, 102 men recurred. Compared with men who had stable weight, those whose weight increased by more than 2.2 kg had twice the recurrence risk (HR = 1.94; 95% CI, 1.14-3.32) after taking into account age, pathologic stage and grade, and other characteristics. The HR of recurrence was 1.20 (95% CI, 0.64-2.23) and 1.72 (95% CI, 0.94-3.14) comparing obesity at 5 years before and at 1 year after surgery, respectively, with normal weight. Physical activity (≥ 5 h/wk) did not attenuate risk in men who gained more than 2.2 kg. By avoiding weight gain, men with prostate cancer may both prevent recurrence and improve overall well-being.
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Affiliation(s)
- Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Rm. E6137, Baltimore, MD 21205, USA.
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Cao Y, Ma J. Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis. Cancer Prev Res (Phila) 2011; 4:486-501. [PMID: 21233290 DOI: 10.1158/1940-6207.capr-10-0229] [Citation(s) in RCA: 333] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increasing evidence suggested obesity, measured by body mass index (BMI), was associated with prostate cancer-specific mortality, and its impact on biochemical recurrence was also inconclusive. We systematically searched MEDLINE, EMBASE, and bibliographies of retrieved studies up to January 5, 2010. We used random-effects meta-analysis to assess the relative risks (RR) of prostate cancer-specific mortality and biochemical recurrence associated with a 5 kg/m(2) increase in BMI. Among the six population-based cohort studies in 1,263,483 initially cancer-free men, 6,817 prostate cancer deaths occurred; a 5 kg/m(2) increase in BMI was associated with 15% (RR: 1.15, 95% confidence interval (CI): 1.06-1.25, P < 0.01) higher risk of dying of prostate cancer. In the six postdiagnosis survival studies on 18,203 patients with 932 prostate cancer deaths, a 5 kg/m(2) increase in BMI was associated with 20% higher prostate cancer-specific mortality (RR: 1.20, 95% CI: 0.99-1.46, P = 0.06). In the sixteen studies which followed 26,479 prostate cancer patients after primary treatment, a 5 kg/m(2) increase in BMI was significantly associated with 21% increased risk of biochemical recurrence (RR: 1.21, 95% CI: 1.11-1.31 P < 0.01). Elevated BMI is associated with risk of prostate cancer-specific mortality in prospective cohort studies and biochemical recurrence in prostate cancer patients. Its association with prostate cancer-specific mortality in diagnosed patients needs to be further evaluated.
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Affiliation(s)
- Yin Cao
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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Geinitz H, Thamm R, Mueller T, Jess K, Zimmermann FB, Molls M, Nieder C. Impact of body mass index on outcomes after conformal radiotherapy in patients with prostate cancer. Int J Radiat Oncol Biol Phys 2010; 81:16-22. [PMID: 20864272 DOI: 10.1016/j.ijrobp.2010.05.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/07/2010] [Accepted: 05/06/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE Several retrospective analyses have suggested that obese men with prostate cancer treated with external beam radiotherapy (EBRT) have outcomes inferior to those of normal-weight men. However, a recently presented analysis for the first time challenged this association between body mass index (BMI) and treatment failure. It is therefore important to provide further data on this issue. METHODS AND MATERIALS This was a retrospective analysis of 564 men treated with risk-adapted conformal EBRT at a single institution. Low-risk patients received EBRT alone, and the other patients received EBRT plus endocrine treatment. In addition, high-risk patients were treated to higher EBRT doses (74 Gy). A rectal balloon catheter for internal immobilization, which can be identified on portal images, was used in 261 patients (46%). Thus, localization did not rely on bony landmarks alone in these cases. RESULTS The median BMI was 26, and 15% of patients had BMI≥30. Neither univariate nor multivariate analyses detected any significant impact of BMI on biochemical relapse, prostate cancer-specific survival, or overall survival. The 5-year biochemical relapse rate was 21% and prostate cancer-specific survival 96%. CONCLUSIONS The present analysis of a large cohort of consecutively treated patients suggests that efforts to reduce prostate movement and geographic miss might result in comparable outcomes in obese and normal-weight patients.
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Affiliation(s)
- Hans Geinitz
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
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Burton AJ, Tilling KM, Holly JM, Hamdy FC, Rowlands MAE, Donovan JL, Martin RM. Metabolic imbalance and prostate cancer progression. INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2010; 1:248-271. [PMID: 21532839 PMCID: PMC3076778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 07/20/2010] [Indexed: 05/30/2023]
Abstract
There is substantial evidence implicating environmental factors in the progression of prostate cancer. The metabolic consequences of a western lifestyle, such as obesity, insulin resistance and abnormal hormone production have been linked to prostate carcinogenesis through multiple overlapping pathways. Insulin resistance results in raised levels of the mitogens insulin and insulin-like growth factor-1, both of which may affect prostate cancer directly, or through their effect on other metabolic regulators. Obesity is associated with abnormal levels of adipocyte-derived peptides (adipokines), sex hormones and inflammatory cytokines. Adipokines have been shown to influence prostate cancer in both cell culture studies and observational, population level studies. Testosterone appears to have a complex relationship with prostate carcinogenesis, and it has been suggested that the lower levels associated with obesity may select for more aggressive androgen independent prostate cancer cells. Prostatic inflammation, caused by infection, urinary reflux or dietary toxins, frequently occurs prior to cancer development and may influence progression to advanced disease. High levels of ω-6 fatty acids in the diet may lead to the production of further inflammatory molecules that may influence prostate cancer. Increased fatty acid metabolism occurs within tumour cells, providing a potential target for prostate cancer therapies. Aberrations in amino acid metabolism have also been identified in prostate cancer tissue, particularly in metastatic cancer. This evidence indicates lifestyle interventions may be effective in reducing the incidence of clinical disease. However, much more research is needed before recommendations are made.
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Lindner U, Lawrentschuk N, Abouassaly R, Fleshner NE, Trachtenberg J. Radical prostatectomy in obese patients: Improved surgical outcomes in recent years. Int J Urol 2010; 17:727-32. [PMID: 20546052 DOI: 10.1111/j.1442-2042.2010.02570.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Obesity has been proposed as a risk factor for reduced disease-specific survival, increased positive surgical margin (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with prostate cancer. The aim of this study was to clarify the relationship between obesity and surgical outcomes in patients undergoing RP. METHODS Medical records of 491 patients who underwent RP from 2004 to 2007 were retrieved from our institutional database. Patients were divided into three groups based on their body mass index (BMI): <25, 25-30 (overweight) and >30 kg/m (obese). Outcomes after RP were compared between the groups in terms of length of stay, perioperative complications, BCR, PSM and Gleason scores. RESULTS Age, stage and preoperative prostate-specific antigen were similar between BMI categories. Operating time was prolonged in obese patients (146 vs 135 min, P = 0.01) and blood loss was greater (mean estimated blood loss 640 vs 504 mL, P = 0.02), but did not translate into higher transfusion rates. Early complication rates, PSM rates and Gleason scores were not statistically different between the groups. Significant differences in late outcomes, such as the need for adjunct procedures or BCR (hazard ratio 0.44, 95% CI 0.18-1.09), were not shown. CONCLUSION As surgical experience with high BMI patients has developed, RP appears to be a well tolerated procedure in contemporary series, irrespective of BMI. In particular, early outcome parameters, such as PSM and BCR rates, are similar.
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Affiliation(s)
- Uri Lindner
- Division of Urology, Department of Surgical Oncology Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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Ly D, Reddy CA, Klein EA, Ciezki JP. Association of body mass index with prostate cancer biochemical failure. J Urol 2010; 183:2193-9. [PMID: 20399465 DOI: 10.1016/j.juro.2010.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Indexed: 01/06/2023]
Abstract
PURPOSE The association between obesity and biochemical failure measured by prostate specific antigen after prostate cancer treatment is controversial. We determined whether there is an association between body mass index and biochemical failure in men treated for low and intermediate risk prostate cancer with various treatment modalities. MATERIALS AND METHODS We performed a cohort study in 2,687 patients who underwent treatment for low and intermediate risk prostate adenocarcinoma as described by National Comprehensive Cancer Network guidelines at Cleveland Clinic between January 1996 and December 2005. Univariate and multivariate analyses were done to determine the effect of multiple patient characteristics on biochemical failure. RESULTS There were 319 biochemical failures (11.9%). Body mass index as a continuous variable was significantly associated with biochemical failure on univariate analysis (HR 1.030, p = 0.02). There was a significant association with biochemical failure when comparing normal vs overweight and normal vs obese men but not overweight vs obese men. On multivariate analysis body mass index as a continuous or a categorical variable was not significantly associated with biochemical failure. Multivariate analysis revealed certain variables significantly associated with biochemical failure, including black race, greater initial prostate specific antigen, Gleason score 7, treatment type and more frequent prostate specific antigen screening. CONCLUSIONS We found a significant association between body mass index and biochemical failure on univariate analysis that did not hold true on multivariate analysis. Black race was associated with biochemical failure on multivariate analysis. The reason for this is unclear. Future studies should further characterize the relationship between race and biochemical failure.
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Affiliation(s)
- David Ly
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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van Roermund JGH, Hinnen KA, Battermann JJ, Witjes JA, Bosch JLHR, Kiemeney LA, van Vulpen M. Body mass index is not a prognostic marker for prostate-specific antigen failure and survival in Dutch men treated with brachytherapy. BJU Int 2009; 105:42-8. [PMID: 19519759 DOI: 10.1111/j.1464-410x.2009.08687.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the relationship between body mass index (BMI) and biochemical recurrence (BCR), cancer-specific (CSS) and overall survival (OS) in men treated with permanent prostate brachytherapy (PPB), as there is limited information on the affect of obesity on treatment outcomes for prostate cancer. PATIENTS AND METHODS In all, 1530 patients with clinically localized prostate cancer who underwent PPB were studied. Clinical and pathological data were retrospectively obtained from medical records. The BMI was classified as normal (< 25 kg/m(2)), overweight (25-30 kg/m(2)) and obese (> or = 30 kg/m(2)). BCR was defined as a rise in PSA levels of > or = 2 ng/mL after the nadir had been reached. The cause of death was determined for each deceased patient. Patients with metastatic prostate cancer who died of any cause were classified as prostate cancer deaths. RESULTS In all, 617 (40%) patients were classified as having a normal weight, 754 (49%) overweight and 159 (10%) were obese. The Kaplan-Meier 8-year risk of BCR (95% confidence interval) was 33.3% (27.2-39.4), 29.2% (23.5-34.9) and 29.3% (12.4-46.2) for patients with a BMI of < 25 kg/m(2), 25-30 kg/m(2) and > or = 30 kg/m(2), respectively. The 8-year CSS was 88.2% (83.1-93.3), 88.6% (83.7-93.5) and 90.6% (79.9-101.4) and the 8-year OS was 70.1% (63.6-76.6), 72.9% (66.6-79.2) and 81.8% (69.3-94.3) for these three groups, respectively. Multivariate proportional hazard regression analyses of BMI and established prognostic factors for BCR confirmed the absence of any prognostic value of BMI on BCR, CSS and OS. CONCLUSIONS BMI did not appear to have any prognostic value for BCR, CCS or OS in patients with clinically localized prostate cancer treated with PPB.
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Affiliation(s)
- Joep G H van Roermund
- Department of Urology, University Medical Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.
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Zhang Q, Helfand BT, Jang TL, Zhu LJ, Chen L, Yang XJ, Kozlowski J, Smith N, Kundu SD, Yang G, Raji AA, Javonovic B, Pins M, Lindholm P, Guo Y, Catalona WJ, Lee C. Nuclear factor-kappaB-mediated transforming growth factor-beta-induced expression of vimentin is an independent predictor of biochemical recurrence after radical prostatectomy. Clin Cancer Res 2009; 15:3557-67. [PMID: 19447876 DOI: 10.1158/1078-0432.ccr-08-1656] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Transforming growth factor-beta (TGF-beta)-mediated epithelial-to-mesenchymal transition (EMT) has been shown to occur in some cancers; however, the pathway remains controversial and varies with different cancers. In addition, the mechanisms by which TGF-beta and the EMT contribute to prostate cancer recurrence are largely unknown. In this study, we elucidated TGF-beta-mediated EMT as a predictor of disease recurrence after therapy for prostate cancer, which has not been reported before. EXPERIMENTAL DESIGN We analyzed TGF-beta-induced EMT using nuclear factor-kappaB (NF-kappaB) as an intermediate mediator in prostate cancer cell lines. A total of 287 radical prostatectomy specimens were evaluated using immunohistochemistry in a high-throughput tissue microarray analysis. Levels of TGF-beta signaling components and EMT-related factors were analyzed using specific antibodies. Results were expressed as the percentage of cancer cells that stained positive for a given antibody and were correlated with disease recurrence rates at a mean of 7 years following radical prostatectomy. RESULTS In prostate cancer cell lines, TGF-beta-induced EMT was mediated by NF-kappaB signaling. Blockade of NF-kappaB or TGF-beta signaling resulted in abrogation of vimentin expression and inhibition of the invasive capability of these cells. There was high risk of biochemical recurrence associated with tumors that displayed high levels of expression of TGF-beta1, vimentin, and NF-kappaB and low level of cytokeratin 18. This was particularly true for vimentin, which is independent of patients' Gleason score. CONCLUSIONS The detection of NF-kappaB-mediated TGF-beta-induced EMT in primary tumors predicts disease recurrence in prostate cancer patients following radical prostatectomy. The changes in TGF-beta signaling and EMT-related factors provide novel molecular markers that may predict prostate cancer outcomes following treatment.
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Affiliation(s)
- Qiang Zhang
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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van Roermund JGH, Kok DEG, Wildhagen MF, Kiemeney LA, Struik F, Sloot S, van Oort IM, Hulsbergen-van de Kaa CA, van Leenders GJLH, Bangma CH, Witjes JA. Body mass index as a prognostic marker for biochemical recurrence in Dutch men treated with radical prostatectomy. BJU Int 2009; 104:321-5. [PMID: 19220264 DOI: 10.1111/j.1464-410x.2009.08404.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate whether body mass index (BMI) is a prognostic factor for biochemical recurrence (BCR) in Dutch men after radical prostatectomy (RP), as although epidemiological studies of obesity in relation to prostate cancer have provided conflicting results, recent studies from the USA suggest that a higher BMI is a risk factor for progression of prostate cancer. PATIENTS AND METHODS Of the 1417 patients with prostate cancer who had RP at two University hospitals, 1302 were included in the present study. BMI (kg/m(2)) classes were defined as normal (<25), overweight (25-30) and obese (> or =30). The median follow-up was 59 months and clinical data were obtained retrospectively from charts. BCR was defined as two consecutive prostate-specific antigen (PSA) levels of >0.1 ng/mL. RESULTS In all, 600 patients were classified as having normal weight (43.9%), 665 as overweight (48.6%) and 103 as obese (7.5%). Overall, 297 patients developed BCR after RP; the 10-year risk (95% confidence interval) of BCR was 31.9 (26.6-37.2)%, 30.5 (25.8-35.2)% and 23.9 (14.9-32.9)% for patients in the three categories, respectively (P = 0.836). Multivariable proportional hazard regression analyses of BMI and established prognostic factors for BCR did not change these results. CONCLUSION BMI appeared to have no prognostic value for BCR in Dutch patients with clinically localized prostate cancer and treated with RP.
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López Fontana C, Eugenia Maselli Artola M, Cristina Vanrell Rodríguez M, Di Milta Mónaco NA, Pérez Elizalde R, López Laur JD. Avances sobre la influencia del tejido adiposo en el adenocarcinoma de próstata. Actas Urol Esp 2009. [DOI: 10.1016/s0210-4806(09)74137-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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