Obesity and mortality in men with locally advanced prostate cancer

Abstract

BACKGROUND.Greater body mass index (BMI) is associated with shorter time to prostate‐specific antigen (PSA) failure following radical prostatectomy and radiation therapy (RT). Whether BMI is associated with prostate cancer‐specific mortality (PCSM) was investigated in a large randomized trial of men treated with RT and androgen deprivation therapy (ADT) for locally advanced prostate cancer.METHODS.Between 1987 and 1992, 945 eligible men with locally advanced prostate cancer were enrolled in a phase 3 trial (RTOG 85‐31) and randomized to RT and immediate goserelin or RT alone followed by goserelin at recurrence. Height and weight data were available at baseline for 788 (83%) subjects. Cox regression analyses were performed to evaluate the relations between BMI and all‐cause mortality, PCSM, and nonprostate cancer mortality. Covariates included age, race, treatment arm, history of prostatectomy, nodal involvement, Gleason score, clinical stage, and BMI.RESULTS.The 5‐year PCSM rate for men with BMI <25 kg/m2 was 6.5%, compared with 13.1% and 12.2% in men with BMI ≥25 to <30 and BMI ≥30, respectively (Gray's P = .005). In multivariate analyses, greater BMI was significantly associated with higher PCSM (for BMI ≥25 to <30, hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.02–2.27, P = .04; for BMI ≥30, HR 1.64, 95% CI, 1.01–2.66, P = .04). BMI was not associated with nonprostate cancer or all‐cause mortality.CONCLUSIONS.Greater baseline BMI is independently associated with higher PCSM in men with locally advanced prostate cancer. Further studies are warranted to evaluate the mechanism(s) for increased cancer‐specific mortality and to assess whether weight loss after prostate cancer diagnosis alters disease course. Cancer 2007. © 2007 American Cancer Society.

The effect of androgen deprivation therapy on body composition in men with prostate cancer: Systematic review and meta-analysis

“…Prostate cancer patients are surviving for longer periods because of earlier diagnosis and treatment and the long-term consequence of ADT on body composition is becoming increasingly important. A high BMI or weight is thought to be a risk factor for the development of high-grade prostate cancer [38] and metastasis [39] and significantly decreases survival rates and life expectancy [39,40]. Furthermore, a recent large observational study has indicated a relationship between an increased incidence of diabetes, coronary heart disease, myocardial infarction and sudden cardiac death with ADT [41].…”

American Society of Clinical Oncology Position Statement on Obesity and Cancer

“…8 • A BMI Ն 35 kg/m 2 may be associated with an increased risk of colon cancer recurrence and mortality, but the data are less consistent. 9,10 • Emerging data suggest that obesity may be a prognostic factor in other malignancies as well.…”

Obesity-related systemic factors promote an invasive phenotype in prostate cancer cells

“…2,3 Specifically, obese men have higher grade Gleason scores, larger tumors and shorter time to PSA failure compared with their lean counterparts. 4 The obesity-cancer progression link may be due in part to dysregulated hormones and obesity-induced inflammation.…”