Elsevier

Urology

Volume 58, Issue 5, November 2001, Pages 723-728
Urology

Adult urology
Relationship between obesity and race in predicting adverse pathologic variables in patients undergoing radical prostatectomy1,

https://doi.org/10.1016/S0090-4295(01)01373-5Get rights and content

Abstract

Objectives. To determine whether obesity is associated with more advanced prostate cancer (PCa) in radical prostatectomy patients and to explore the ethnic variability in body mass index (BMI) as a potential explanation for racial differences in PCa risk.

Methods. A multi-institutional retrospective analysis of the clinical and pathologic parameters was performed on data from 860 patients with PCa undergoing radical prostatectomy between 1992 and 1998. Patient height and weight was used to calculate the BMI, which categorized patients into obese (BMI 30 kg/m2 or greater), overweight (BMI 25 to 30 kg/m2), and normal (BMI 25 kg/m2 or less) groups. Age, serum prostate-specific antigen level, pathologic stage, and Gleason score for each group were compared. The distribution of the BMI in each of four ethnic groups was also determined.

Results. Of 860 patients, 171 (20%) were obese, 425 (49%) overweight, and 264 (31%) normal. The obese patients presented at a younger mean age (62 years, P = 0.001), had higher mean Gleason scores (6.7, P = 0.002), had a higher likelihood of Gleason score 7 or greater cancer (71%, P = 0.003), and had a lower chance of organ-confined cancer (46%, P = 0.050). The BMI was highest in blacks, followed by whites and Asians, and blacks had significantly higher grade cancers (P = 0.045). In multiple logistic regression analysis of the BMI and race, only BMI remained an independent predictor of Gleason grade.

Conclusions. Obese patients with PCa present for radical prostatectomy at a younger age with higher grade and more pathologically advanced cancers. Blacks have higher grade cancers than other ethnic groups and, at the same time, have significantly higher BMIs. These findings suggest that obesity may in part account for the racial variability in PCa risk.

Section snippets

Material and methods

The Center for Prostate Disease Research Triservice Multicenter Longitudinal Prostate Cancer Database was queried to identify patients undergoing RP at three military medical centers: Naval Medical Center, San Diego, California; Madigan Army Medical Center, Tacoma, Washington; and Wilford Hall Medical Center, San Antonio, Texas. At these institutions, a total of 860 patients undergoing RP between 1993 and 1998 were identified. The Center for Prostate Disease Research Database uses standardized

Results

Of 860 patients, 171 (20%) were categorized as obese, 425 (49%) as overweight, and 264 (31%) as normal according to the BMI determination. Table I shows the sample sizes, mean (with standard deviation), percentage, and test outcome (P values) for comparison of the three BMI categories on the basis of the demographic and pathologic variables. The age at presentation for RP was significantly lower in patients with higher degrees of obesity (P = 0.001). As the BMI increased, the percentage of

Comment

Numerous studies have suggested an association between dietary fat intake and prostate cancer risk, and some have proposed that dietary fat may promote the development of more lethal cancers.3, 4, 5, 6, 7, 8, 9, 10 Because obesity may be an end result of higher fat diets, we hypothesized that obesity may be associated with the earlier development of advanced disease in patients undergoing RP. Our results show that obese patients present for RP at a younger age, with higher grade and more

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      Citation Excerpt :

      In this report we found that BMI is a significant independent predictor of BRFS (mild HR 1.30, p = 0.002; moderate/severe HR 1.45, p = 0.028) and OS (mild HR 1.41, p = 0.003; moderate/severe HR 1.81, p = 0.033), but only mild obesity predicted PCSS (HR 1.51, p = 0.040) whereas moderate/severe obesity did not (HR 1.58, p = 0.356). Obesity is associated with higher grade and stage disease at diagnosis9,10 as well as after treatment with radical prostatectomy.14–16 To date, most reports of a higher BMI-worse BRFS association after RP have fewer than 5 years of followup.17–20

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    Research supported by the Center for Prostate Disease Research, a Department of Defense program of the Uniformed Services University of the Health Sciences funded by the U.S. Army Medical Research and Materiel Command.

    1

    The opinions and assertions contained herein are the views of the authors and are not to be construed as reflecting the views of the U.S. Navy, Army, Air Force, or Department of Defense.

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