BMI correlates to risk for biochemical recurrence post-surgery

According to data presented on Tuesday at the American Association for Cancer Research annual meeting in Chicago, body mass index (BMI)  at the time of surgery correlates with risk for biochemical recurrence of prostate cancer after first-line treatment with radical prostatectomy.

Most prior studies that have suggested a connection between excess weight/body mass and risk for progression of prostate cancer have been retrospective in nature. The new data presented by Freeman et al. this week are based on a prospective assessment of the projected outcomes of men awaiting radical prostatectomies for clinically localized prostate cancer at four urology clinics in the Chicago area.

The investigators carefully assessed the pre-treatment risk of biochemical progression (using the D’Amico risk criteria) and the body mass status of this cohort of patients and then sought to understand the correlation between D’Amico risk score and BMI. The core results of this study were that:

  • Risk of biochemical recurrence increased with increasing quartile of BMI.
  • Compared to the men in the lowest quartile for BMI
    • Men in the second quartile for BMI (mean BMI 27.8 kg/m2) were at 3.51 times  higher risk for an intermediate or high D’Amico risk score.
    • Men in the third quartile for BMI (mean BMI 32.0 kg/m2) were at 6.52 times  higher risk for an intermediate or high D’Amico risk score.
    • Men in the fourth quartile for BMI (mean BMI 37.0 kg/m2) were at 7.74 times  higher risk for an intermediate or high D’Amico risk score.

Based on these data it appears very clear that BMI is predictive for biochemical failure after surgery in men with clinically localized prostate cancer. The authors further suggest that these findings offer “further support for a mechanistic link between body weight status, which reflects energy balance, and prostate cancer prognosis.”

What we do not know (yet) from this study is whether the projections based on BMI are borne out in clinical practice. It is to be hoped that these 119 men with be followed for at least 5 years to see if the BMI-based risk for recurrence is actually demonstrated in clinical practice.

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