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Journal Article•DOI•

Body mass index in relation to serum prostate-specific antigen levels and prostate cancer risk.

Stephanie E Bonn1, Arvid Sjölander1, Annika Tillander1, Fredrik Wiklund1, Henrik Grönberg1, Katarina Bälter2, Katarina Bälter1 •
Karolinska Institutet1, Stanford University2
01 Jul 2016-International Journal of Cancer (Int J Cancer)-Vol. 139, Iss: 1, pp 50-57
TL;DR: BMI was inversely associated to PSA‐levels, and should be taken into consideration when referring men to a prostate biopsy based on serum PSA•levels, according to findings regarding risk.
Abstract: High Body mass index (BMI) has been directly associated with risk of aggressive or fatal prostate cancer. One possible explanation may be an effect of BMI on serum levels of prostate-specific antigen (PSA). To study the association between BMI and serum PSA as well as prostate cancer risk, a large cohort of men without prostate cancer at baseline was followed prospectively for prostate cancer diagnoses until 2015. Serum PSA and BMI were assessed among 15,827 men at baseline in 2010-2012. During follow-up, 735 men were diagnosed with prostate cancer with 282 (38.4%) classified as high-grade cancers. Multivariable linear regression models and natural cubic linear regression splines were fitted for analyses of BMI and log-PSA. For risk analysis, Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) and natural cubic Cox regression splines producing standardized cancer-free probabilities were fitted. Results showed that baseline Serum PSA decreased by 1.6% (95% CI: -2.1 to -1.1) with every one unit increase in BMI. Statistically significant decreases of 3.7, 11.7 and 32.3% were seen for increasing BMI-categories of 25 < 30, 30 < 35 and ≥35 kg/m(2), respectively, compared to the reference (18.5 < 25 kg/m(2)). No statistically significant associations were seen between BMI and prostate cancer risk although results were indicative of a positive association to incidence rates of high-grade disease and an inverse association to incidence of low-grade disease. However, findings regarding risk are limited by the short follow-up time. In conclusion, BMI was inversely associated to PSA-levels. BMI should be taken into consideration when referring men to a prostate biopsy based on serum PSA-levels.
Citations
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Journal Article•DOI•
Prospective investigation of risk factors for prostate cancer in the UK Biobank cohort study.

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Aurora Perez-Cornago1, Timothy J. Key1, Naomi E. Allen2, Georgina K. Fensom1, Kathryn E. Bradbury1, Richard M. Martin, Ruth C. Travis1 •
Cancer Epidemiology Unit1, Clinical Trial Service Unit2
07 Nov 2017-British Journal of Cancer
TL;DR: Prostate cancer risk was positively associated with the following: black ethnicity, black vs white, and having ever had a prostate-specific antigen test, which are all known risk factors for prostate cancer.
Abstract: Prostate cancer is the most common cancer in British men but its aetiology is not well understood. We aimed to identify risk factors for prostate cancer in British males. We studied 219 335 men from the UK Biobank study who were free from cancer at baseline. Exposure data were collected at recruitment. Prostate cancer risk by the different exposures was estimated using multivariable-adjusted Cox proportional hazards models. In all, 4575 incident cases of prostate cancer occurred during 5.6 years of follow-up. Prostate cancer risk was positively associated with the following: black ethnicity (hazard ratio black vs white=2.61, 95% confidence interval=2.10–3.24); having ever had a prostate-specific antigen test (1.31, 1.23–1.40); being diagnosed with an enlarged prostate (1.54, 1.38–1.71); and having a family history of prostate cancer (1.94, 1.77–2.13). Conversely, Asian ethnicity (Asian vs white hazard ratio=0.62, 0.47–0.83), excess adiposity (body mass index (⩾35 vs <25 kg m−2=0.75, 0.64–0.88) and body fat (⩾30.1 vs <20.5%=0.81, 0.73–0.89)), cigarette smoking (current vs never smokers=0.85, 0.77–0.95), having diabetes (0.70, 0.62–0.80), and never having had children (0.89, 0.81–0.97) or sexual intercourse (0.53, 0.33–0.84) were related to a lower risk. In this new large British prospective study, we identified associations with already-established, putative and possible novel risk factors for being diagnosed with prostate cancer. Future research will examine associations by tumour characteristics.

71 citations

Cites result from "Body mass index in relation to seru..."

  • ...Exposure data included information on socio-demographic factors (region, Townsend deprivation index, education level, ethnicity, employment, and living with a wife or partner), anthropometric measurements (standing height, weight, BMI, percentage body fat, waist and hip circumferences, waist to hip ratio (WHR) (UK-Biobank, 2014)), lifestyle characteristics (smoking status, alcohol consumption, and physical activity), healthrelated factors (vasectomy, hypertension, and diabetes), prostatespecific factors prior to recruitment (PSA test, enlarged prostate, and family history of prostate cancer), sexual history (number of children, age at first sexual intercourse, lifetime heterosexual partners, same-sex intercourse, and lifetime number of same-sex partners), early life factors (puberty as defined by age of first facial hair, relative age voice broke, and comparative body size and height at age 10 years), and hair colour and balding pattern....

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  • ...In particular, fat mass estimated using bioimpedance is a better marker of overall adiposity than BMI or waist circumference, which does not differentiate between muscle and fat mass....

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  • ...On the basis of results from the minimally adjusted Cox regression analyses, the multivariable-adjusted model was additionally adjusted for Townsend deprivation score (fifths, unknown (0.1%)), ethnicity (white, mixed background, Asian, black, other, and unknown (0.7%)), lives with a wife or partner (no, yes), BMI (o25, X25–o30, X30–o35, X35 kg m 2, and unknown (0.6%)), cigarette smoking (never, former, current, and unknown (0.7%)), physical activity (low (0–o10 metabolic equivalents (METs) per week), moderate (X10–o50 METs per week), high (X50 METs per week), and unknown (3.7%)), diabetes (no, yes, and unknown (0.6%)), enlarged prostate (no or unknown, and yes), and family history of prostate cancer (no, yes (brother or father), and unknown (45.1%))....

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  • ...Participants provided detailed self-reported data via a touch screen questionnaire and a verbal interview with a trained nurse at the assessment centres at baseline (Sudlow et al, 2015), and a wide range of physical measurements (e.g., body mass index (BMI) and including bioimpedance) and biological samples were collected (Sudlow et al, 2015)....

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  • ...Previous prospective investigations have also found a link between excess adiposity, typically as estimated by BMI or waist circumference, and a lower risk of overall prostate cancer risk (Perez-Cornago et al, 2017; WCRF/AICR, 2014)....

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Journal Article•DOI•
Systematic review and meta-analysis of the associations between body mass index, prostate cancer, advanced prostate cancer, and prostate-specific antigen

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Sean Harrison1, Kate Tilling1, Emma L Turner1, Richard M. Martin2, Richard M. Martin1, Rosie J. Lennon3, J. Athene Lane1, J. Athene Lane2, Jenny L Donovan4, Jenny L Donovan1, Freddie C. Hamdy5, David E. Neal6, David E. Neal5, J.L.H. Ruud Bosch7, Hayley E Jones1 •
University of Bristol1, University Hospitals Bristol NHS Foundation Trust2, University of York3, National Institute for Health Research4, University of Oxford5, University of Cambridge6, University Medical Center Utrecht7
11 Mar 2020-Cancer Causes & Control
TL;DR: There is little or no evidence of a association between BMI and risk of prostate cancer or advanced prostate cancer, and strong evidence of an inverse and non-linear association between body mass index and PSA.
Abstract: The relationship between body mass index (BMI) and prostate cancer remains unclear. However, there is an inverse association between BMI and prostate-specific antigen (PSA), used for prostate cancer screening. We conducted this review to estimate the associations between BMI and (1) prostate cancer, (2) advanced prostate cancer, and (3) PSA. We searched PubMed and Embase for studies until 02 October 2017 and obtained individual participant data from four studies. In total, 78 studies were identified for the association between BMI and prostate cancer, 21 for BMI and advanced prostate cancer, and 35 for BMI and PSA. We performed random-effects meta-analysis of linear associations of log-PSA and prostate cancer with BMI and, to examine potential non-linearity, of associations between categories of BMI and each outcome. In the meta-analyses with continuous BMI, a 5 kg/m2 increase in BMI was associated with a percentage change in PSA of − 5.88% (95% CI − 6.87 to − 4.87). Using BMI categories, compared to normal weight men the PSA levels of overweight men were 3.43% lower (95% CI − 5.57 to − 1.23), and obese men were 12.9% lower (95% CI − 15.2 to − 10.7). Prostate cancer and advanced prostate cancer analyses showed little or no evidence associations. There is little or no evidence of an association between BMI and risk of prostate cancer or advanced prostate cancer, and strong evidence of an inverse and non-linear association between BMI and PSA. The association between BMI and prostate cancer is likely biased if missed diagnoses are not considered.

45 citations

Journal Article•DOI•
Obesity and prostate cancer.

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Marco Bandini1, Giorgio Gandaglia2, Alberto Briganti2•
Università telematica San Raffaele1, Vita-Salute San Raffaele University2
01 Sep 2017-Current Opinion in Urology
TL;DR: Obesity may facilitate the development and progression of PCa trough different biologic mechanisms that may pose obese men at higher risk of advanced and high-grade disease, however, the association between obesity and long-term oncologic outcome after radical treatments appears unclear.
Abstract: Purpose of reviewTo investigate the association between obesity and prostate cancer (PCa).Recent findingsObesity has been proposed to be involved in the pathogenesis of PCa through different biological mechanisms that include deregulation of the insulin axis, sex hormone secretion, adipokines signal

39 citations

Journal Article•DOI•
Association of obesity status and metabolic syndrome with site-specific cancers: a population-based cohort study.

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Zhi Cao1, Xiaomin Zheng2, Hongxi Yang1, Hongxi Yang3, Shu Li1, Fusheng Xu1, Xilin Yang1, Yaogang Wang1 •
Tianjin Medical University1, Anhui Medical University2, Yale University3
30 Jul 2020-British Journal of Cancer
TL;DR: Even in metabolically healthy individuals, obesity was associated with increased risks of five cancers, whereas it was found that these individuals were associated withincreased risks of several other obesity-related cancers.
Abstract: Obesity and metabolic syndrome (MetS) appear in clusters and are both associated with an increased risk of cancer. However, it remains unknown whether obesity status with or without MetS increases the risk of site-specific cancers. We used data derived from 390,575 individuals (37–73 years old) from the UK Biobank who were enrolled from 2006–2016 with a median of 7.8 years of follow-up. Obesity was defined by BMI ≥ 30 kg/m2 and MetS was defined by the criteria of the Adult Treatment Panel-III (ATP-III). Cox proportional hazards models were used to investigate the associations of BMI and MetS with 22 cancers. Metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) phenotypes represented 6.7% and 17.9% of the total analytic samples and 27.1% and 72.9% of the included subpopulation with obesity, respectively. Obesity was independently associated with higher risks of 10 of 22 cancers. Stratified by metabolic status, the MUO phenotype was consistently associated with 10 obesity-related cancers. In contrast, the MHO phenotype was only associated with increased risks of five cancers: endometrium, oesophagus, kidney, pancreas and postmenopausal breast cancers. Even in metabolically healthy individuals, obesity was associated with increased risks of five cancers, whereas we did not find that these individuals were associated with increased risks of several other obesity-related cancers.

35 citations

Journal Article•DOI•
Diet, Physical Activity, and Body Weight in Cancer Survivorship.

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Karishma Mehra1, Alyssa Berkowitz1, Tara Sanft1•
Yale University1
01 Nov 2017-Medical Clinics of North America
TL;DR: There are compelling data that appropriate diet, physical activity, and body weight have beneficial effects in cancer survivorship, but additional trials are needed to understand the relationship.

32 citations

Cites background from "Body mass index in relation to seru..."

  • ...Engaging in 20 min/d versus less than 20 min/d of postdiagnosis moderate walking/bicycling was associated with a 39% reduced risk of disease-specific mortality and engaging in 1 versus less than 1 h/wk of moderate-vigorous exercise was associated with a 32% lower risk of disease-specific mortality.(76) In all of these studies, men who were in the highest categories of physical activities tended to be younger, less likely to smoke, and have a lower BMI....

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"Body mass index in relation to seru..." refers methods in this paper

  • ...To summarize the fitted spline models, regression standardization was used, in which the predicted means obtained from the adjusted (for confounders) spline function were standardized to the confounder distribution in the sample.(24) In all models, the association between BMI and serum PSA was studied separately for all men, men diagnosed with prostate cancer during the follow-up, and men without a diagnosis during follow-up....

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Journal Article•DOI•
International Variation in Prostate Cancer Incidence and Mortality Rates

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Ahmedin Jemal1, Joannie Lortet-Tieulent2, Elizabeth Ward1, Jacques Ferlay2, Otis W. Brawley1, Freddie Bray2 •
American Cancer Society1, International Agency for Research on Cancer2
01 Jun 2012-European Urology
TL;DR: PCa incidence rates increased in nearly all countries considered in this analysis except in a few high-income countries, and the increase in PCa mortality rates mainly occurred in lower resource settings, with declines largely confined to high-resource countries.

1,362 citations

"Body mass index in relation to seru..." refers background in this paper

  • ...While incidence rates have increased, partly because of the widespread use of prostate-specific antigen (PSA) testing as a diagnostic tool, during previous decades, they have stabilized at a high level over the past 10 years.(2) Co-occurring with the increasing prostate cancer incidence is an increased prevalence of overweight and obesity....

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Related Papers (5)
Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer.

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21 Nov 2007-JAMA
Lionel L. Bañez, Robert J. Hamilton, Robert J. Hamilton, Alan W. Partin, Robin T. Vollmer, Leon Sun, Carmen Rodriguez, Yiting Wang, Martha K. Terris, Martha K. Terris, William J. Aronson, Joseph C. Presti, Christopher J. Kane, Christopher J. Kane, Christopher L. Amling, Judd W. Moul, Stephen J. Freedland 
Systematic Review and Meta-Analysis of the Associations Between Body Mass Index, Prostate Cancer, Advanced Prostate Cancer and Prostate Specific Antigen

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Sean Harrison, Kate Tilling, Emma L Turner, Richard M. Martin, Richard M. Martin, Rosie J. Lennon, J. Athene Lane, J. Athene Lane, Jenny L Donovan, Jenny L Donovan, Freddie C. Hamdy, David E. Neal, David E. Neal, J.L.H. Ruud Bosch, Hayley E Jones 
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Yasuaki Kubota, Kensaku Seike, Shin-ichi Maeda, Yuka Shinohara, Masamitsu Iwata, Norio Sugimoto 
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Reina Haque, Stephen K. Van Den Eeden, Lauren P. Wallner, Kathryn Richert-Boe, Bhaskar Kallakury, Renyi Wang, Sheila Weinmann 
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