Prostate cancer recurrence and obesity


A new analysis of data from the Shared Equal Access Regional Cancer Hospital (SEARCH) prostate cancer database has suggested that obese men with prostate cancer are at particularly high risk for recurrence of their disease — regardless of race.

Prior studies have suggested the possibility that obesity is linked to worse outcomes in many cancers, including prostate cancer. Because there is a higher prevalence of obesity among black men with prostate cancer, compared to whites, and because black Americans are more likely than whites to develop and die from prostate cancer it had beensuggested that obesity might be a more ominous risk factor for blacks than for whites.

Jayachandran et al. have now demonstrated that this is not the case. “Obesity leads to worse cancer in both groups,” according to Stephen Freedland, an associate professor of urology and pathology at the Duke Prostate Center and the senior author of the study, who was quoted in a media release from Duke Comprehensive Cancer Center.

The research group examined the records of 1,415 men enrolled in the SEARCH database who had undergone a radical prostatectomy. Black men comprised almost half (47 percent) of the sample. After adjusting for various preoperative characteristics, ther authors analyzed the relationship between body mass index (BMI) and the aggressiveness of the cancer, as measured by the risk of recurrence. In contrast to other studies, investigators found no association between race and obesity.

Almost a third of the men were obese, regardless of race. “We found that higher BMI was associated with significantly increased risk of cancer recurrence for both blacks and whites,” Jayachandran said. “Though prior SEARCH-based studies from our group found that obesity was associated with a higher risk of disease progression as measured by a rising PSA after surgery, it now appears that being obese just means a poorer prognosis, period, regardless of race.”

The research team is not yet able to explain why there is a higher risk for disease recurrence in obese patients, but they have speculated that it may have something to do with altered hormone levels.

“Obesity is associated with more estrogen and less testosterone, and it may be that lower testosterone promotes more aggressive tumors as recent studies have suggested,” Jayachandran said. Furthermore, alteration in the production of other hormones, like insulin, insulin-like growth factor or leptin, which occur in obese men, may also be involved in the development of more aggressive tumors.

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