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Abstract and Introduction
Abstract
Objectives: Prostate cancer screening algorithms and preoperative nomograms do not include patients' body mass index (BMI). We evaluated outcomes at radical prostatectomy (RP) adjusted to BMI.
Methods: Serum prostate-specific antigen (PSA) levels, PSA mass, PSA density (PSAD), and RP findings were analyzed with respect to BMI in 4,926 men who underwent RP between 2005 and 2014.
Results: In total, 1,001 (20.3%) men were normal weight, 2,547 (51.7%) were overweight, and 1,378 (28%) were obese. Median PSA levels (ng/mL) were normal weight, 5.0; overweight, 5.1; and obese, 5.2 (P = .094). Median PSA mass increased with increasing BMI: 15.9 vs 17.4 vs 19.4 μg (P < .001). Median PSAD was not significantly different: 0.11 vs 0.11 vs 0.11 ng/mL/g (P = .084). Median prostate weight increased with increasing BMI: 44 vs 45 vs 49 g (P < .001). Median prostatectomy tumor volume increased with increasing BMI: 3.9 vs 4.7 vs 5.9 cm (P < .001). Overweight and obese patients had a higher Gleason score and more locally advanced cancer (P < .001). Frequency of positive surgical margins increased with higher BMIs (P < .001). Frequency of lymph node metastasis did not differ significantly (P = .088).
Conclusions: While BMI correlates with tumor volume, Gleason score, and extent of disease at RP, there is no routinely measured clinical parameter reflecting this. Only PSA mass highlights this correlation. Thus, BMI and potentially PSA mass should be taken into account in predictive algorithms pertaining to prostate cancer and its surgical treatment.
Introduction
Currently, patient age and results of digital rectal examination (DRE) are the two clinical variables used to modify serum prostate-specific antigen (PSA) level to indicate to which men prostate biopsy should be recommended. According to the latest recommendation of the American Urological Association (2013), the following guidelines have been suggested regarding early detection of prostate cancer with PSA screening in four tiers of age groups: (1) younger than 40 years, recommendation against PSA screening; (2) 40 to 54 years, PSA screening not recommended unless in high-risk patients (eg, family history or African American race); (3) 55 to 69 years, shared decision making with PSA screening every 2 years; and (4) 70 years or older or life expectancy less than 10 to 15 years, PSA screening not recommended. Because serum PSA level is often equivocal, ancillary methods that attempt to improve PSA specificity have also been introduced: PSA velocity, PSA density (PSAD), and molecular forms of PSA (free vs bound). Even with these modifications, PSA level remains only modestly related to prostate tumor burden or to locally or systemically advanced disease among men in whom the histologic diagnosis of prostate cancer has been established. In cancers in other organs, body mass index (BMI) has shown its prognostic significance. This study investigates the relation of normal, overweight, and obese ranges of BMI to PSA levels, PSAD, PSA mass, and pathologic findings in consecutive patients who underwent radical prostatectomy (RP) at a single institution. We analyzed the above variables with respect to immediate outcome at RP, recognizing that the overall and biochemical recurrence-free survival are influenced by cancer features at RP and comorbidities associated with higher BMIs.
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