Basic and Translational ScienceBody Mass Index Adjusted Prostate-specific Antigen and Its Application for Prostate Cancer Screening
Section snippets
Material and Methods
The San Antonio Center of Biomarkers of Risk for Prostate Cancer (SABOR) is a National Cancer Institute, Early Detection Research Network–sponsored Clinical Validation Center. SABOR has enrolled community-dwelling men in a biomarker validation cohort since 2000. From this cohort, we identified 3697 men (3432 noncancers and 265 cancers) who were enrolled between November 2000 to May 2009 for this analysis. In these subjects, age, PSA, BMI, DRE, race, first-degree family history of PCa, and
Results
Characteristics of participants are summarized in Table 1. There was no significant difference between cancers and noncancers with regard to mean BMI (P = .20) but some evidence of a shift in the distribution across categories of BMI (P = .06 in Table 1 and P = .03 after combining the OBII and OBIII categories). Among cancers, BMI category did not correlate with high-grade (Gleason score ≥7) PCa (P = .75 and P = .74 for before and after the OBII/OBIII combination, respectively). The area under
Comment
Associations between increased BMI and decreased PSA have previously been reported by many researchers.3, 4, 5, 6, 7, 8, 9, 10 Two explanations have been advanced to explain the lower levels of PSA among obese men: a hemodilution effect as a result of greater blood volume or suppression of PSA production caused by lower testosterone levels and higher estrogen levels among obese men.12, 13, 14, 15, 16 Beyond PCa detection, outcomes after treatment for PCa have been found by several investigators
Conclusions
We observed that increased BMI is not a risk factor for PCa among our SABOR participants. Adjustment for diminished levels of PSA in the general population does not increase the accuracy of PSA-based risk assessment. However, because of lower levels of PSA, overweight and obese men may suffer diminished cancer detection opportunities when undergoing PSA screening and a BMI-based PSA adjustment may be considered.
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Cited by (19)
Variations in prostate biopsy recommendation and acceptance confound evaluation of risk factors for prostate cancer: Examining race and BMI
2019, Cancer EpidemiologyCitation Excerpt :Liang et al estimated BMI-adjusted PSA factors using PCPT data. We used adjusted PSA values in the PCPT risk calculator [18]. Our approach differed slightly from Barrington et al. [8].
Overweight or not-Prostate-specific antigen levels reflect a continuum of risk influenced by other factors
2016, Urologic Oncology: Seminars and Original InvestigationsContemporary outcomes in the detection of prostate cancer using transrectal ultrasound-guided 12-core biopsy in Singaporean men with elevated prostate specific antigen and/or abnormal digital rectal examination
2015, Asian Journal of UrologyCitation Excerpt :We reduced this variability by having a standardised protocol for our ultrasound and biopsy method. Many studies have attempted to investigate ways to improve the diagnostic ability of serum PSA such as by adjusting for age, prostate volume and body mass index [40–42] and we will be looking into the application of such adjustments and/or nomograms in our local population. In our current retrospective study, we endeavored to evaluate the detection rates of prostate cancer using serum PSA levels and DRE findings.
Is there a role for body mass index in the assessment of prostate cancer risk on biopsy?
2014, Journal of UrologyCitation Excerpt :Age and BMI were collected at the date of the most recent biopsy. BMI adjusted PSA was calculated by multiplying the most recent PSA by 1.09, 1.20, 1.50 and 1.71 for men in overweight (BMI 25 to less than 30 kg/m2), obese I (BMI 30 to less than 35 kg/m2), obese II (BMI 35 to less than 40 kg/m2) and obese III (BMI 40 kg/m2 or greater) categories, respectively.18 Information on race/ethnicity and first-degree family history of PCa was collected at study entry.
Prostate cancer risk prediction in a urology clinic in Mexico
2013, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :These patients generally have higher PSA levels and more frequent abnormalities on digital rectal examination (DRE). While integration of PSA and DRE with other risk factors for CaP, such as family history in a first-degree relative, has resulted in increased accuracy of diagnostic testing for CaP in the U.S., it is not clear that integration of multiple risk factors will have a similar benefit in a referral population in Mexico [2–11]. The Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) provides individualized risk estimates of CaP and high-grade prostate cancer (HGCaP, Gleason score ≥ 7) on prostate biopsy, and is recommended by the American Cancer Society for early detection of CaP and, most importantly, HGCaP [3,12].
Reply by authors
2011, Journal of Urology
Financial support provided by the Early Detection Research Network, National Cancer Institute, National Institutes of Health, Grant (U01-CA86402) and the San Antonio Cancer Institute (P30-CA54174).