Influence of body mass index and periprostatic fat on rectal dosimetry in permanent seed prostate brachytherapy

Tiberi, David; Gruszczynski, Nelson; Meissner, Aliza; Delouya, Guila; Taussky, Daniel

doi:10.1186/1748-717x-9-93

Cited by 8 publications

(11 citation statements)

References 19 publications

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“…Similar observations were reported by Tiberi et al. , who defined PPAT as the contour at the level of the superior border of the symphysis pubis with exclusion of the tissue medial to the levator ani muscles on both the anterior and posterior aspects of the CT image, and van Roermund et al. , who defined PPAT in a transverse section at the level of the caput femoris and greater trochanter of the femur.…”

Section: Relationships Between Peri‐prostatic Adipose Tissue and Prossupporting

confidence: 76%

“…The accumulated weight of evidence to date supports an association between PPAT quantity and increased PCa aggressiveness, although the mechanistic basis of this association remains inconclusive and has limited the development of potential interventions. Measuring PPAT area or density showed more significant correlations with PCa aggressiveness than measuring general obesity markers BMI and waist circumference , while the correlation of PPAT thickness with BMI or weight was non‐significant or weak . Moreover, no association has been demonstrated between subcutaneous adipose thickness and PCa aggressiveness ; thus, PPAT measurements may serve as an independent predictor of PCa aggressiveness rather than as a surrogate measure for body adiposity.…”

Section: Discussionmentioning

confidence: 88%

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Peri‐prostatic adipose tissue: the metabolic microenvironment of prostate cancer

et al. 2018

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Emerging data have linked certain features of clinical prostate cancer (PCa) to obesity and, more specifically, increased adiposity. Whereas the large number of clinical studies and meta-analyses that have explored the associations between PCa and obesity have shown considerable variability, particularly in relation to prostate cancer risk, there is an accumulating weight of evidence consistently linking obesity to greater aggressiveness of disease. In probing this association mechanistically, it has been posited that peri-prostatic adipose tissue (PPAT), a significant component of the prostate microenvironment, may be a critical source of fatty acids and other mitogens and thereby influences PCa pathogenesis and progression. Notably, several recent studies have identified secreted factors from both PPAT and PCa that potentially mediate the two-way communication between these intimately linked tissues. In the present review, we summarize the available literature regarding the relationship between PPAT and PCa, including the potential biological mediators of that relationship, and explore emerging areas of interest for future research endeavours.

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Section: Relationships Between Peri‐prostatic Adipose Tissue and Prossupporting

confidence: 76%

Section: Discussionmentioning

confidence: 88%

Peri‐prostatic adipose tissue: the metabolic microenvironment of prostate cancer

et al. 2018

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“…This is contrary to our previous publication (Tiberi et al, 2014), where our group was able to show a weak correlation between BMI, VAT, SAT and PPAT. Additionally, we found that PPAT is independent of BMI, compared to the volume and density of VAT and SAT which were correlated with BMI.…”

Section: Discussioncontrasting

confidence: 99%

“…Additionally, we found that PPAT is independent of BMI, compared to the volume and density of VAT and SAT which were correlated with BMI. This is contrary to our previous publication (Tiberi et al, 2014), where our group was able to show a weak correlation between BMI, VAT, SAT and PPAT. This could be because of the fact that the PPAT was defined differently in this study.…”

Section: Discussioncontrasting

confidence: 99%

Changes in periprostatic adipose tissue induced by 5α‐reductase inhibitors

et al. 2017

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There is increasing interest in periprostatic fat and its influence on prostate cancer aggressiveness. In vitro data suggest that adipose stromal/stem cells (ASCs) can increase production of cytokines and growth factors resulting in invasive growth and metastasis in prostate cancer. The objective of the study was to determine the interaction between 5α-reductase inhibitors (5ARIs) and periprostatic adipose tissue (PPAT) and factors of prostate cancer aggressiveness. In this retrospective study, we identified 61 patients treated with 5ARIs for a period of ≥12 months before undergoing radiation therapy (brachytherapy or external beam radiotherapy). The control group consisted of 117 patients without any exposure to 5ARIs. Prior to being treated, all patients underwent abdominal computed tomography (CT). To measure PPAT, we defined the fat pad anteriorly to the prostate, as well as the intra-abdominal visceral adipose tissue (VAT) and subcutaneous tissue (SAT) at the level of L4/L5. All contours were performed manually. These adipose tissue measurements were correlated with the Cancer of the Prostate Risk Assessment (CAPRA) score using Pearson correlation coefficient. Differences in fat contents were evaluated using Student's t-test. Median time on 5ARIs for the 61 patients was 12 months (range 12-96). Patient on 5ARIs had a significantly (p < 0.001) smaller PPAT (0.4, SD 0.5) than patients without a 5ARI (0.6 cc, SD 0.4). There was no significant correlation between the CAPRA score and fat measurements when adjusted for 5ARI use (p = 0.18). In non-5ARI users, BMI was not correlated with PPAT but was correlated with SAT and VAT volume and its density. There were no significant differences in diabetics (p = 0.3), metformin users (p = 0.4) or statin users (p = 0.09) between both groups. 5ARIs taken for at least 12 months induce changes in PPAT volume. Whether these changes or the extent of changes will have an influence on outcome remains unknown.

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“…Tiberi et al . also found a negative correlation between BMI and dose to the rectum [23]. In addition to affecting rectal dose, we suggest that prostate-rectum interface adipose tissue can also have a negative effect on the anterior dose received by the prostate.…”

Section: Discussionmentioning

confidence: 54%

The impact of body mass index on dosimetric quality in low-dose-rate prostate brachytherapy

Echevarria

Naghavi

Venkat

et al. 2016

jcb

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PurposeLow-dose-rate (LDR) brachytherapy has been established as an effective and safe treatment option for men with low and intermediate risk prostate cancer. In this retrospective analysis, we sought to study the effect of body mass index (BMI) on post-implant dosimetric quality.Material and methodsAfter institutional approval, records of patients with non-metastatic prostate cancer treated in Puerto Rico with LDR brachytherapy during 2008-2013 were reviewed. All patients were implanted with 125I seeds to a prescription dose of 145 Gy. Computed tomography (CT) based dosimetry was performed 1 month after implant. Patients with at least 1 year of prostate-specific antigen (PSA) follow-up were included. Factors predictive of adequate D90 coverage (≥ 140 Gy) were compared via the Pearson χ2 or Wilcoxon rank-sum test as appropriate.ResultsOne-hundred and four patients were included in this study, with 53 (51%) patients having a D90 ≥ 140 Gy. The only factor associated with a dosimetric coverage detriment (D90 < 140 Gy) was BMI ≥ 25 kg/m2 (p = 0.03). Prostate volume (p = 0.26), initial PSA (p = 0.236), age (p = 0.49), hormone use (p = 0.93), percent of cores positive (p = 0.95), risk group (p = 0.24), tumor stage (p = 0.66), and Gleason score (p = 0.61) did not predict D90.ConclusionsIn this study we show that BMI is a significant pre-implant predictor of D90 (< 140 Gy vs. ≥ 140 Gy). Although other studies have reported that prostate volume also affects D90, our study did not find this correlation to be statistically significant, likely because all of our patients had a prostate volume < 50 cc. Our study suggests that in patients with higher BMI values, more rigorous peri-implant dosimetric parameters may need to be applied in order to achieve a target D90 > 140 Gy.

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Influence of body mass index and periprostatic fat on rectal dosimetry in permanent seed prostate brachytherapy

Cited by 8 publications

References 19 publications

Peri‐prostatic adipose tissue: the metabolic microenvironment of prostate cancer

Peri‐prostatic adipose tissue: the metabolic microenvironment of prostate cancer

Changes in periprostatic adipose tissue induced by 5α‐reductase inhibitors

The impact of body mass index on dosimetric quality in low-dose-rate prostate brachytherapy

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