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Gregg JR, Magill R, Fang AM, Chapin BF, Davis JW, Adibi M, Chéry L, Papadopoulos J, Pettaway C, Pisters L, Ward JF, Hahn AW, Daniel CR, Bhaskaran J, Zhu K, Guerrero M, Zhang M, Troncoso P. The association of body mass index with tumor aggression among men undergoing radical prostatectomy. Urol Oncol 2024; 42:116.e1-116.e7. [PMID: 38262868 DOI: 10.1016/j.urolonc.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To evaluate the association of preoperative body mass index (BMI) on adverse pathology in peripheral (PZ) and transition zone (TZ) tumors at time of prostatectomy for localized prostate cancer. METHODS Clinical and pathologic characteristics were obtained from up to 100 consecutive prostatectomy patients from 10 prostate surgeons. BMI groups included normal (18.5-24.9), overweight (25-29.9) and obese (> 29.9). "Aggressive" pathology was defined as the presence of Grade Group (GG) 3 or higher and/or pT3a or higher. Pathologic characteristics were evaluated for association with BMI using univariate analyses. Our primary outcome was the association of BMI with adverse pathology, which was assessed using logistic regression accounting for patient age. We hypothesized that obese BMI would be associated with aggressive TZ tumor. RESULTS Among 923 patients, 140 (15%) were classified as "normal" BMI, 413 (45%) were "overweight", and 370 (40%) were "obese." 474 patients (51%) had aggressive PZ tumors while 102 (11%) had aggressive TZ tumors. "Obese" BMI was not associated with aggressive TZ tumor compared to normal weight. Increasing BMI group was associated with overall increased risk of aggressive PZ tumor (HR 1.56 [95CI 1.04-2.34]; P = 0.03). Among patients with GG1 or GG2, increasing BMI was associated with presence of pT3a or higher TZ tumor (P = 0.03). CONCLUSIONS Increased BMI is associated with adverse pathology in PZ tumors. TZ adverse pathology risk may be increased among obese men with GG1 or GG2 disease, which has implications for future studies assessing behavioral change among men whose tumors are actively monitored.
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Affiliation(s)
- Justin R Gregg
- MD Anderson Cancer Center, University of Texas, Houston, TX.
| | - Resa Magill
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Andrew M Fang
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Brian F Chapin
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - John W Davis
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Mehrad Adibi
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Lisly Chéry
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | | | | | - Louis Pisters
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - John F Ward
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Andrew W Hahn
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | | | | | - Keyi Zhu
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | | | - Miao Zhang
- MD Anderson Cancer Center, University of Texas, Houston, TX
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Saha A, Kolonin MG, DiGiovanni J. Obesity and prostate cancer - microenvironmental roles of adipose tissue. Nat Rev Urol 2023; 20:579-596. [PMID: 37198266 DOI: 10.1038/s41585-023-00764-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/19/2023]
Abstract
Obesity is known to have important roles in driving prostate cancer aggressiveness and increased mortality. Multiple mechanisms have been postulated for these clinical observations, including effects of diet and lifestyle, systemic changes in energy balance and hormonal regulation and activation of signalling by growth factors and cytokines and other components of the immune system. Over the past decade, research on obesity has shifted towards investigating the role of peri-prostatic white adipose tissue as an important source of locally produced factors that stimulate prostate cancer progression. Cells that comprise white adipose tissue, the adipocytes and their progenitor adipose stromal cells (ASCs), which proliferate to accommodate white adipose tissue expansion in obesity, have been identified as important drivers of obesity-associated cancer progression. Accumulating evidence suggests that adipocytes are a source of lipids that are used by adjacent prostate cancer cells. However, results of preclinical studies indicate that ASCs promote tumour growth by remodelling extracellular matrix and supporting neovascularization, contributing to the recruitment of immunosuppressive cells, and inducing epithelial-mesenchymal transition through paracrine signalling. Because epithelial-mesenchymal transition is associated with cancer chemotherapy resistance and metastasis, ASCs are considered to be potential targets of therapies that could be developed to suppress cancer aggressiveness in patients with obesity.
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Affiliation(s)
- Achinto Saha
- Division of Pharmacology and Toxicology and Dell Paediatric Research Institute, The University of Texas at Austin, Austin, TX, USA
- Center for Molecular Carcinogenesis and Toxicology, The University of Texas at Austin, Austin, TX, USA
- Livestrong Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Mikhail G Kolonin
- The Brown Foundation Institute of Molecular Medicine for the Prevention of Disease, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA.
| | - John DiGiovanni
- Division of Pharmacology and Toxicology and Dell Paediatric Research Institute, The University of Texas at Austin, Austin, TX, USA.
- Center for Molecular Carcinogenesis and Toxicology, The University of Texas at Austin, Austin, TX, USA.
- Livestrong Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
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3
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Purcell SA, Oliveira CLP, Mackenzie M, Robson P, Lewis JD, Prado CM. Body Composition and Prostate Cancer Risk: A Systematic Review of Observational Studies. Adv Nutr 2022; 13:1118-1130. [PMID: 34918023 PMCID: PMC9340980 DOI: 10.1093/advances/nmab153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/13/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Body composition parameters are not captured by measures of body mass, which may explain inconsistent associations between body weight and prostate cancer (PC) risk. The objective of this systematic review was to characterize the association between fat mass (FM) and fat-free mass (FFM) parameters and PC risk. A search of PubMed, Embase, and Web of Science identified case-control and cohort studies that measured body composition in relation to PC risk. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Thirteen observational studies were included, of which 8 were case-control studies (n = 1572 cases, n = 1937 controls) and 5 were prospective cohort studies (n = 7854 incident cases with PC). The NOS score was 5.9 ± 1.1 for case-control studies and 8.4 ± 1.3 for cohort studies. The most common body composition technique was bioelectrical impedance analysis (n = 9 studies), followed by DXA (n = 2), computed tomography (n = 2), air displacement plethysmography (n = 1), and MRI (n = 1). No case-control studies reported differences in %FM between PC cases and controls and no consistent differences in FM or FFM (in kilograms) were observed. Two out of 5 cohort studies reported that higher %FM was associated with lower PC risk. Conversely, 3 cohort studies reported a greater risk of being diagnosed with advanced/aggressive PC with higher FM (expressed in kilograms, %FM, or fat distribution). Two out of 4 studies (both case-control and cohort) found that higher abdominal adipose tissue was associated with increased PC risk. In conclusion, although results were inconsistent, there is some evidence that FM may be negatively associated with total PC risk but positively associated with the risk of advanced/aggressive PC; modest evidence suggests that abdominal adipose tissue may increase the risk of PC. Future work should elucidate unique patterns of FM distribution and PC risk to triage men at risk for developing PC. This study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database as CRD42019133388.
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Affiliation(s)
- Sarah A Purcell
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Camila L P Oliveira
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Mackenzie
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Paula Robson
- Cancer Care Alberta and the Cancer Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - John D Lewis
- Department of Experimental Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Carla M Prado
- Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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4
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Agalliu I, Lin WKJ, Zhang JS, Jacobson JS, Rohan TE, Adusei B, Snyper NYF, Andrews C, Sidahmed E, Mensah JE, Biritwum R, Adjei AA, Okyne V, Ainuson-Quampah J, Fernandez P, Irusen H, Odiaka E, Folasire OF, Ifeoluwa MG, Aisuodionoe-Shadrach OI, Nwegbu MM, Pentz A, Chen WC, Joffe M, Neugut AI, Diallo TA, Jalloh M, Rebbeck TR, Adebiyi AO, Hsing AW. Overall and central obesity and prostate cancer risk in African men. Cancer Causes Control 2022; 33:223-239. [PMID: 34783926 PMCID: PMC8776598 DOI: 10.1007/s10552-021-01515-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/29/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE African men are disproportionately affected by prostate cancer (PCa). Given the increasing prevalence of obesity in Africa, and its association with aggressive PCa in other populations, we examined the relationship of overall and central obesity with risks of total and aggressive PCa among African men. METHODS Between 2016 and 2020, we recruited 2,200 PCa cases and 1,985 age-matched controls into a multi-center, hospital-based case-control study in Senegal, Ghana, Nigeria, and South Africa. Participants completed an epidemiologic questionnaire, and anthropometric factors were measured at clinic visit. Multivariable logistic regression was used to examine associations of overall and central obesity with PCa risk, measured by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), respectively. RESULTS Among controls 16.4% were obese (BMI ≥ 30 kg/m2), 26% and 90% had WC > 97 cm and WHR > 0.9, respectively. Cases with aggressive PCa had lower BMI/obesity in comparison to both controls and cases with less aggressive PCa, suggesting weight loss related to cancer. Overall obesity (odds ratio: OR = 1.38, 95% CI 0.99-1.93), and central obesity (WC > 97 cm: OR = 1.60, 95% CI 1.10-2.33; and WHtR > 0.59: OR = 1.68, 95% CI 1.24-2.29) were positively associated with D'Amico intermediate-risk PCa, but not with risks of total or high-risk PCa. Associations were more pronounced in West versus South Africa, but these differences were not statistically significant. DISCUSSION The high prevalence of overall and central obesity in African men and their association with intermediate-risk PCa represent an emerging public health concern in Africa. Large cohort studies are needed to better clarify the role of obesity and PCa in various African populations.
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Affiliation(s)
- Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA.
| | - Wei-Kaung Jerry Lin
- Stanford School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Janice S Zhang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
- Stanford School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Judith S Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA
| | | | | | | | - Elkhansa Sidahmed
- Dana Farber Cancer Institute, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James E Mensah
- Korle-Bu Teaching Hospital and University of Ghana, Accra, Ghana
| | - Richard Biritwum
- Korle-Bu Teaching Hospital and University of Ghana, Accra, Ghana
| | - Andrew A Adjei
- College of Health Sciences, University of Ghana Medical School, Accra, Ghana
| | - Victoria Okyne
- Korle-Bu Teaching Hospital and University of Ghana, Accra, Ghana
| | - Joana Ainuson-Quampah
- College of Health Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | | | | | - Emeka Odiaka
- College of Medicine and University College Hospital, University of Ibadan, Ibadan, Nigeria
| | | | | | - Oseremen I Aisuodionoe-Shadrach
- College of Health Sciences, University of Abuja, and University of Abuja Teaching Hospital and Cancer Science Centre, Abuja, Nigeria
| | - Maxwell Madueke Nwegbu
- College of Health Sciences, University of Abuja, and University of Abuja Teaching Hospital and Cancer Science Centre, Abuja, Nigeria
| | - Audrey Pentz
- Non-Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa
| | - Wenlong Carl Chen
- Non-Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alfred I Neugut
- Departments of Medicine and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Thierno Amadou Diallo
- Institut de Formation et de la Recherche en Urologie et de la Santé Familiale, Hôpital Général de Grand Yoff, Dakar, Senegal
| | - Mohamed Jalloh
- Institut de Formation et de la Recherche en Urologie et de la Santé Familiale, Hôpital Général de Grand Yoff, Dakar, Senegal
| | - Timothy R Rebbeck
- Dana Farber Cancer Institute, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Ann W Hsing
- Stanford School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA, USA.
- Stanford Cancer Institute, 780 Welch Road, Room 250D, Stanford, CA, 94305, USA.
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5
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Chau CH, Till C, Price DK, Goodman PJ, Neuhouser ML, Pollak MN, Thompson IM, Figg WD. Serum markers, obesity and prostate cancer risk: results from the prostate cancer prevention trial. Endocr Relat Cancer 2022; 29:99-109. [PMID: 34889205 PMCID: PMC8776589 DOI: 10.1530/erc-21-0107] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022]
Abstract
Molecular mechanisms linking obesity to prostate cancer involve steroid hormone and insulin/insulin-like growth factor 1 (IGF1) pathways. We investigated the association of circulating serum markers (e.g. androgens and IGFs/IGFBPs) with BMI and in modifying the association of obesity with prostate cancer risk. Data and specimens for this nested case-control study are from the Prostate Cancer Prevention Trial, a randomized, placebo-controlled trial of finasteride for prostate cancer prevention. Presence or absence of cancer was determined by prostate biopsy. Serum samples were assayed for sex steroid hormone concentrations and IGF1 axis analytes. Logistic regression estimated odds ratio and 95% CIs for risk of overall, low-grade (Gleason 2-6), and high-grade (Gleason 7-10) cancers. We found significant associations between BMI with serum steroids and IGFs/IGFBPs; the IGF1 axis was significantly associated with several serum steroids. Serum steroid levels did not affect the association of BMI with prostate cancer risk; however, IGFBP2 and IGFs modified the association of obesity with low- and high-grade disease. While serum steroids and IGFs/IGFBPs are associated with BMI, only the IGF1 axis contributed to obesity-related prostate cancer risk. Understanding the biological mechanisms linking obesity to prostate cancer risk as it relates to circulating serum markers will aid in developing effective prostate cancer prevention strategies and treatments.
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Affiliation(s)
- Cindy H. Chau
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Cathee Till
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Douglas K. Price
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Phyllis J. Goodman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marian L. Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Ian M. Thompson
- CHRISTUS Santa Rosa Hospital Medical Center, San Antonio, TX
| | - William D. Figg
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
- Corresponding author: William D. Figg, 9000 Rockville Pike, Bldg. 10/Room 5A01, Bethesda, MD 20892, USA, Tel: +1-240-760-6179/Fax: +1-240-858-3020,
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6
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Vallières E, Mésidor M, Roy-Gagnon MH, Richard H, Parent MÉ. General and abdominal obesity trajectories across adulthood, and risk of prostate cancer: results from the PROtEuS study, Montreal, Canada. Cancer Causes Control 2021; 32:653-665. [PMID: 33818663 DOI: 10.1007/s10552-021-01419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/16/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Greater body fatness is a probable cause of advanced prostate cancer (PCa). Body fat distribution and timing of exposure may be relevant. We investigated associations between body size trajectories and PCa incidence in a population-based case-control study in Montreal, Canada. METHODS Cases (n = 1,931), aged ≤ 75 years, were diagnosed with PCa in 2005-2009; 1,994 controls were selected from the electoral list. Interviews were conducted to assess body mass index (BMI) and Stunkard's silhouette at ages 20, 40, 50, 60 years, and before interview. Current waist and hip circumferences were measured, and a predictive model estimated waist circumference in the past. BMI and waist circumference trajectories were determined to identify subgroups. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between anthropometric indicators and PCa. RESULTS Subjects with a current BMI ≥ 30 kg/m2 had a lower risk of overall PCa (OR 0.71, 95% CI 0.59-0.85). Associations with adult BMI followed similar trends for less and more aggressive tumors, with stronger inverse relationships in early adulthood. Contrastingly, current waist circumference ≥ 102 cm was associated with elevated risk of high-grade PCa (OR 1.33, 95% CI 1.03-1.71). Men with increasing BMI or waist circumference adult trajectories had a lower risk of PCa, especially low-grade, than those in the normal-stable range. This was especially evident among men in the obese-increase group for BMI and waist circumference. CONCLUSION Abdominal obesity increased the risk of aggressive PCa. The inverse relationship between body size trajectories and PCa may reflect PSA hemodilution, lower detection, and/or a true etiological effect.
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Affiliation(s)
- Eric Vallières
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, University of Quebec, 531 Boul. des Prairies, Laval, QC, H7V 1B7, Canada.,School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 avenue du Parc, Montreal, QC, H3N 1X9, Canada
| | - Miceline Mésidor
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, University of Quebec, 531 Boul. des Prairies, Laval, QC, H7V 1B7, Canada.,School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 avenue du Parc, Montreal, QC, H3N 1X9, Canada.,University of Montreal Hospital Research Centre, 900 Saint-Denis, Tour Viger, Pavillon R, Montreal, QC, H2X 0A9, Canada
| | - Marie-Hélène Roy-Gagnon
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Hugues Richard
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, University of Quebec, 531 Boul. des Prairies, Laval, QC, H7V 1B7, Canada
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, University of Quebec, 531 Boul. des Prairies, Laval, QC, H7V 1B7, Canada. .,School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 avenue du Parc, Montreal, QC, H3N 1X9, Canada. .,University of Montreal Hospital Research Centre, 900 Saint-Denis, Tour Viger, Pavillon R, Montreal, QC, H2X 0A9, Canada.
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7
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Family history of prostate cancer and prostate tumor aggressiveness in black and non-black men;results from an equal access biopsy study. Cancer Causes Control 2021; 32:337-346. [PMID: 33532986 PMCID: PMC7946692 DOI: 10.1007/s10552-020-01389-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
Purpose To test for racial differences in associations between family history (FH) of prostate cancer (PC) and prostate cancer aggressiveness in a racially diverse equal access population undergoing prostate biopsy. Subjects/patients and methods We prospectively enrolled men undergoing prostate biopsy at the Durham Veterans Administration from 2007 to 2018 and assigned case or control status based on biopsy results. Race and FH of PC were self-reported on questionnaires. Logistic regression was used to test the association between FH and PC diagnosis overall and by tumor aggressiveness [high- (Grade Group 3–5) or low-grade (Grade Group 1–2) vs. no cancer], overall, and stratified by race. Models were adjusted for age and year of consent, race, PSA level, digital rectal exam findings, prostate volume, and previous (negative) biopsy receipt. Results Of 1,225 men, 323 had a FH of PC and 652 men were diagnosed with PC on biopsy. On multivariable analysis, FH was associated with increased odds of high-grade PC in black (OR 1.85, p = 0.041) and all men (OR 1.56, p = 0.057) and was unrelated to overall or low-grade PC diagnosis, overall, or stratified by race (all p ≥ 0.325). In sensitivity analyses among men without a previous biopsy, results were slightly more pronounced. Conclusion In this setting of equal access to care, positive FH of PC was associated with increased tumor aggressiveness in black men, but not non-black men undergoing prostate biopsy. Further research is required to tease apart the contribution of genetics from increased PC awareness potentially influencing screening and biopsy rates in men with FH. Supplementary Information The online version of this article (10.1007/s10552-020-01389-8) contains supplementary material, which is available to authorized users.
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8
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Vallières E, Roy-Gagnon MH, Parent MÉ. Body shape and pants size as surrogate measures of obesity among males in epidemiologic studies. Prev Med Rep 2020; 20:101167. [PMID: 32939332 PMCID: PMC7479209 DOI: 10.1016/j.pmedr.2020.101167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023] Open
Abstract
Alternative anthropometric indicators reflect overall and abdominal obesity in males. Abdominal obesity is predicted using age, pants size, Stunkard’s silhouette & weight. Stunkard’s silhouette scale reflects well body mass index recently and in the past.
This study aimed at characterizing anthropometric indicators that can be used as alternatives to measurements for assessing overall obesity over adulthood and abdominal obesity among men. We used data from a population-based case-control study of prostate cancer conducted in Montreal, Canada in 2005–2012. It included men aged ≤ 75 years, 1872 of which were newly diagnosed with prostate cancer, and 1918 others randomly selected from the electoral list. In-person interviews elicited reports of height as well as of weight, pants size and Stunkard’s silhouette at 5 time points over adulthood, i.e., for the ages of 20, 40, 50 and 60 years, if applicable, and at the time of interview. Waist and hip circumferences were measured by interviewers following a validated protocol. Analyses were conducted on the overall sample of 3790 subjects, after having confirmed that results did not differ according to disease status. Stunkard’s silhouette scale proved to be an easy-to-administer tool that reflects well reported body mass index, either recently or decades in the past among adult males. It was discriminatory enough to classify individuals according to commonly-used obesity categories. We observed that a model including age, reported pants size, silhouette and weight can reasonably predict current abdominal obesity. In conclusion, alternative anthropometric indicators can serve as valuable means to assess overall and abdominal obesity when measurements cannot be envisaged in the context of epidemiological studies.
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Affiliation(s)
- Eric Vallières
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, University of Quebec, 531 Boul. Des Prairies, Laval, QC H7V 1B7, Canada.,School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada
| | - Marie-Hélène Roy-Gagnon
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, University of Quebec, 531 Boul. Des Prairies, Laval, QC H7V 1B7, Canada.,School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada.,University of Montreal Hospital Research Centre, 900 Saint-Denis, Tour Viger, Pavillon R, Montreal, QC H2X 0A9, Canada
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9
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Choi JB, Myong JP, Lee Y, Kim I, Kim JH, Hong SH, Ha US. Does increased body mass index lead to elevated prostate cancer risk? It depends on waist circumference. BMC Cancer 2020; 20:589. [PMID: 32576177 PMCID: PMC7313154 DOI: 10.1186/s12885-020-07089-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background We examined the association between obesity and prostate cancer based on both body mass index (BMI) and waist circumference (WC) using the National Health Insurance System (NHIS) database for the entire male population of Korea. Methods A total of 1,917,430 men who underwent at least one health examination in 2009 without a previous diagnosis of any other cancer were tracked through December 2015. The hazard ratio (HR) and 95% confidence interval (CI) value for the association between prostate cancer and obesity were analyzed using multiple Cox regression model. Since there was a statistically significant interaction between WC and BMI, a multiple HR for prostate cancer was estimated with stratifying both WC and BMI to control the interaction between WC and BMI. Results Without considering WC as an adjustment factor, very weak association between BMI and prostate cancer development risk was observed. When WC was considered as an adjustment factor, no significant change in the HRs for prostate cancer development beyond the reference BMI was observed in the group with WC < 85 cm in the multivariable-adjusted models. However, in the group with WC ≥ 85 cm, the HRs for prostate cancer increased as the BMI increased beyond the reference BMI. In addition, there was a discrepancy in the trend of prostate cancer development according to BMI among the groups with different categories for WC. Conclusion In groups with abdominal obesity, a significant linear relationship was observed between increasing BMI and prostate cancer risk. Higher the WC category, the stronger was the association with BMI, signifying that the association of BMI with risk of prostate cancer development depends on abdominal obesity.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yunhee Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Jung Ho Kim
- Department of Urology, Dongnam Institute of Radiological & Medical Sciences, Cancer Center, Busan, South Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South Korea.
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10
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Dickerman BA, Torfadottir JE, Valdimarsdottir UA, Giovannucci E, Wilson KM, Aspelund T, Tryggvadottir L, Sigurdardottir LG, Harris TB, Launer LJ, Gudnason V, Markt SC, Mucci LA. Body fat distribution on computed tomography imaging and prostate cancer risk and mortality in the AGES-Reykjavik study. Cancer 2019; 125:2877-2885. [PMID: 31179538 DOI: 10.1002/cncr.32167] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/07/2018] [Accepted: 12/24/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The World Cancer Research Fund classifies as "strong evidence" the link between obesity and the risk of advanced prostate cancer. In light of the different hormonal profiles associated with where adipose is stored, this study investigated the role of objectively measured body fat distribution and the risk of clinically relevant prostate cancer. METHODS This was a prospective study of 1832 men in the Age, Gene/Environment Susceptibility-Reykjavik study. From 2002 to 2006, participants underwent baseline computed tomography imaging of fat deposition, bioelectric impedance analysis, and measurement of body mass index (BMI) and waist circumference. Men were followed through linkage with nationwide cancer registries for the incidence of total (n = 172), high-grade (Gleason grade ≥8; n = 43), advanced (≥cT3b/N1/M1 at diagnosis or fatal prostate cancer over follow-up; n = 41), and fatal prostate cancer (n = 31) through 2015. Cox regression was used to evaluate the association between adiposity measures and prostate cancer outcomes. RESULTS Among all men, visceral fat (hazard ratio [HR], 1.31 per 1-standard deviation [SD] increase; 95% confidence interval [CI], 1.00-1.72) and thigh subcutaneous fat (HR, 1.37 per 1-SD increase; 95% CI, 1.00-1.88) were associated with risk of advanced and fatal disease, respectively. Among men who were leaner based on BMI, visceral fat was associated with both advanced and fatal disease. BMI and waist circumference were associated with a higher risk of advanced and fatal disease. No adiposity measures were associated with total or high-grade disease. CONCLUSIONS Specific fat depots as well as BMI and waist circumference were associated with the risk of aggressive prostate cancer, which may help to elucidate underlying mechanisms and target intervention strategies.
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Affiliation(s)
- Barbra A Dickerman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Johanna E Torfadottir
- Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Icelandic Cancer Registry, Reykjavik, Iceland
| | - Unnur A Valdimarsdottir
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kathryn M Wilson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thor Aspelund
- Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lara G Sigurdardottir
- Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Education and Prevention, Icelandic Cancer Society, Reykjavik, Iceland
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Vilmundur Gudnason
- Icelandic Cancer Registry, Reykjavik, Iceland.,Icelandic Heart Association, Kopavogur, Iceland
| | - Sarah C Markt
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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11
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Griffin K, Csizmadi I, Howard LE, Pomann GM, Aronson WJ, Kane CJ, Amling CL, Cooperberg MR, Terris MK, Beebe-Dimmer J, Freedland SJ. First-year weight loss with androgen-deprivation therapy increases risks of prostate cancer progression and prostate cancer-specific mortality: results from SEARCH. Cancer Causes Control 2019; 30:259-269. [PMID: 30701374 PMCID: PMC6599459 DOI: 10.1007/s10552-019-1133-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/17/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE We aimed to study the associations between androgen-deprivation therapy (ADT)-induced weight changes and prostate cancer (PC) progression and mortality in men who had undergone radical prostatectomy (RP). METHODS Data from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort were used to study the associations between weight change approximately 1-year post-ADT initiation and metastases, castration-resistant prostate cancer (CRPC), all-cause mortality (ACM), and PC-specific mortality (PCSM) in 357 patients who had undergone RP between 1988 and 2014. We estimated hazard ratios (HR) and 95% confidence intervals (95% CI) using covariate-adjusted Cox regression models for associations between weight loss, and weight gains of 2.3 kg or more, and PC progression and mortality post-ADT. RESULTS During a median (IQR) follow-up of 81 (46-119) months, 55 men were diagnosed with metastases, 61 with CRPC, 36 died of PC, and 122 died of any cause. In multivariable analysis, weight loss was associated with increases in risks of metastases (HR 3.13; 95% CI 1.40-6.97), PCSM (HR 4.73; 95% CI 1.59-14.0), and ACM (HR 2.16; 95% CI 1.25-3.74) compared with mild weight gains of ≤ 2.2. Results were slightly attenuated but remained statistically significant in analyses that accounted for competing risks of non-PC death. Estimates for the associations between weight gains of ≥ 2.3 kg and metastases (HR 1.58; 95% CI 0.73-3.42), CRPC (HR 1.33; 95% CI 0.66-2.66), and PCSM (HR 2.44; 95% CI 0.84-7.11) were elevated, but not statistically significant. CONCLUSIONS Our results suggest that weight loss following ADT initiation in men who have undergone RP is a poor prognostic sign. If confirmed in future studies, testing ways to mitigate weight loss post-ADT may be warranted.
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Affiliation(s)
- Kagan Griffin
- Urology Section, Department of Surgery, Veterans Affairs Medical Centers, Durham, NC, USA
| | - Ilona Csizmadi
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lauren E Howard
- Urology Section, Department of Surgery, Veterans Affairs Medical Centers, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - William J Aronson
- Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA, USA
| | - Christopher J Kane
- Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA, USA
| | - Christopher L Amling
- Division of Urology, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Martha K Terris
- Urology Section, Division of Surgery, Veterans Affairs Medical Center and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | | | - Stephen J Freedland
- Urology Section, Department of Surgery, Veterans Affairs Medical Centers, Durham, NC, USA.
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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12
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Michael J, Oyekunle T, Howard L, De Hoedt A, Hoyo C, Grant D, Freedland S. Interplay between exercise and BMI; results from an equal access, racially diverse biopsy study. Cancer Causes Control 2018; 30:13-20. [PMID: 30523509 DOI: 10.1007/s10552-018-1104-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE It is unclear if exercise and BMI interact to influence prostate cancer (PC) risk. We hypothesized BMI is linked with increased aggressive PC risk but this link will be attenuated with increased exercise. METHODS Men undergoing prostate biopsy completed a questionnaire and metabolic equivalent (MET) hours of exercise was calculated. Of 695 men, 349 had PC; 161 low-grade, and 188 high-grade. We assessed the link between exercise and PC risk, high-grade PC (Gleason 7-10), and low-grade PC (Gleason 2-6) using logistic and multinomial logistic regression. Analysis was stratified by BMI. Link between BMI and PC risk and aggressive PC was similarly tested. RESULTS On multivariable analysis, there was no link between exercise and PC diagnosis in the entire cohort (p trend = 0.18-0.71) or across BMI groups (p trend = 0.15-0.97). For the entire cohort, higher BMI was linked with increased risk of high-grade PC (OR 1.06, p = 0.008). When stratified by exercise groups, the trend for higher BMI and increased risk of high-grade PC remained (OR 1.03-1.15, p = 0.02-0.66). There were no interactions between exercise and BMI in predicting PC risk (all p ≥ 0.31). CONCLUSIONS Regardless of exercise, higher BMI was linked with higher risk of aggressive PC, while exercise was unrelated to PC risk. Confirmatory studies are needed.
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Affiliation(s)
- Jamie Michael
- Division of Urology, Veterans Affairs Medical Center, Durham, NC, USA
| | - Taofik Oyekunle
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Lauren Howard
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
| | - Amanda De Hoedt
- Division of Urology, Veterans Affairs Medical Center, Durham, NC, USA
| | - Catherine Hoyo
- Epidemiology and Environmental Epigenomics, North Carolina State University, Raleigh, NC, USA
| | - Delores Grant
- Department of Biological and Biomedical Sciences, NC Central University, Durham, NC, USA
| | - Stephen Freedland
- Division of Urology, Veterans Affairs Medical Center, Durham, NC, USA. .,Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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13
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Abdominal obesity and prostate cancer risk: epidemiological evidence from the EPICAP study. Oncotarget 2018; 9:34485-34494. [PMID: 30349643 PMCID: PMC6195387 DOI: 10.18632/oncotarget.26128] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022] Open
Abstract
Obesity is associated with an increased risk of several cancers, but inconsistent results have been observed between body mass index (BMI) and prostate cancer (PCa) risk. However, some associations have been reported with other indicators such as waist circumference (WC) and waist-hip ratio (WHR). We investigated the role of anthropometric indicators in PCa risk based on data from the Epidemiological study of Prostate Cancer (EPICAP). EPICAP is a population-based case-control study that included 819 incident PCa in 2012–2013 and 879 controls frequency matched by age. Anthropometric indicators (weight, height, WC, and hip circumference) have been measured at interview. Logistic regression models were used to assess odds ratios (ORs) for the associations between anthropometric indicators (BMI, WC and WHR) and PCa risk. We observed a slight, but not significant increased risk of PCa for men with a WC > 94 cm (OR 1.20, 95% CI 0.92–1.56) and for men with a WHR ≥ 0.95 (OR 1.30, 95% CI 1.00–1.70 between 0.95 and 1.00, OR 1.25, 95% CI 0.96–1.61 above 1.00). Associations were more pronounced after adjustment and stratification for BMI and in men with aggressive PCa. Our results suggest that abdominal obesity may be associated with an increased risk of PCa, especially aggressive PCa.
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14
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Bernstein AP, Fram EB, Sankin A, Kovac E, Srivastava A, DiVito J, Stern JM. A comparison of perinephric fat surface area and Mayo Adhesive Probability score in predicting malignancy in T1 renal masses. Urol Oncol 2018; 36:499.e17-499.e22. [PMID: 30166240 DOI: 10.1016/j.urolonc.2018.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses. METHODS A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade. RESULTS A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7%) had low-grade and 78 (35.3%) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR = 1.374, 95% CI: 1.007-1.873, P = 0.045), male sex (OR = 2.058, 95% CI: 1.004-4.218, P = 0.049), and BMI (OR = 1.064, 95% CI: 0.998-1.135, P = 0.059). Neither MAP nor PFA was predictive of Fuhrman grade. CONCLUSIONS MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis.
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Affiliation(s)
| | - Ethan B Fram
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Medical Arts Pavilion, Bronx, NY
| | - Alexander Sankin
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Medical Arts Pavilion, Bronx, NY
| | - Evan Kovac
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Medical Arts Pavilion, Bronx, NY
| | - Abhishek Srivastava
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Medical Arts Pavilion, Bronx, NY
| | - Joseph DiVito
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Medical Arts Pavilion, Bronx, NY
| | - Joshua M Stern
- Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Medical Arts Pavilion, Bronx, NY.
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15
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Vidal AC, Howard LE, de Hoedt A, Kane CJ, Terris MK, Aronson WJ, Cooperberg MR, Amling CL, Freedland SJ. Obese patients with castration-resistant prostate cancer may be at a lower risk of all-cause mortality: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int 2018. [PMID: 29521009 DOI: 10.1111/bju.14193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess whether obesity is associated with progression to metastasis, prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM), in patients with non-metastatic castration-resistant prostate cancer (non-mCRPC). At the population level, obesity is associated with prostate cancer mortality; however, some studies have found that higher body mass index (BMI) is associated with better long-term prostate cancer outcomes amongst men with mCRPC. PATIENTS AND METHODS We identified 1 192 patients with non-mCRPC from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BMI was calculated from height and weight abstracted from the medical records at the time closest to but prior to CRPC diagnosis and categorised as underweight (<21 kg/m2 ), normal weight (21-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), and obese (≥30 kg/m2 ). Competing risks regression and Cox models were used to test associations between obesity and progression to metastasis, PCSM, and ACM, accounting for confounders. RESULTS Overall, 51 (4%) men were underweight, 239 (25%) were normal weight, 464 (39%) were overweight, and 438 (37%) were obese. In adjusted analysis, higher BMI was significantly associated with reduced ACM (hazard ratio [HR] 0.98, P = 0.012) but not PCSM (HR 1.00, P = 0.737) or metastases (HR 0.99, P = 0.225). Likewise, when BMI was treated as a categorical variable in adjusted models, obesity was not associated with PCSM (HR 1.11, P = 0.436) or metastases (HR 1.06, P = 0.647), but was associated with decreased ACM (HR 0.79, P = 0.016) compared to normal weight. No data were available on treatments received after CRPC diagnosis. CONCLUSIONS Amongst patients with non-mCRPC obesity was associated with better overall survival. Although this result mirrors evidence from men with mCRPC, obesity was not associated with prostate cancer outcomes. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Adriana C Vidal
- Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Lauren E Howard
- Urology Section, VA Medical Center, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | | | - Christopher J Kane
- Urology Department, University of California San Diego Health System, San Diego, CA, USA
| | - Martha K Terris
- Section of Urology, VA Medical Center Augusta, Augusta, GA, USA.,Section of Urology, Medical College of Georgia, Augusta, GA, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Urology, School of Medicine, University of California, Los Angeles, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | | | - Stephen J Freedland
- Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.,Urology Section, VA Medical Center, Durham, NC, USA
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