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BJU Int. 2018 Jul;122(1):76-82. doi: 10.1111/bju.14193. Epub 2018 Apr 10.

Obese patients with castration-resistant prostate cancer may be at a lower risk of all-cause mortality: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

Author information

1
Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
2
Urology Section, VA Medical Center, Durham, NC, USA.
3
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
4
Urology Department, University of California San Diego Health System, San Diego, CA, USA.
5
Section of Urology, VA Medical Center Augusta, Augusta, GA, USA.
6
Section of Urology, Medical College of Georgia, Augusta, GA, USA.
7
Urology Section, Department of Surgery, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
8
Department of Urology, School of Medicine, University of California, Los Angeles, CA, USA.
9
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
10
Division of Urology, Oregon Health Sciences University, Portland, OR, USA.

Abstract

OBJECTIVE:

To assess whether obesity is associated with progression to metastasis, prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM), in patients with non-metastatic castration-resistant prostate cancer (non-mCRPC). At the population level, obesity is associated with prostate cancer mortality; however, some studies have found that higher body mass index (BMI) is associated with better long-term prostate cancer outcomes amongst men with mCRPC.

PATIENTS AND METHODS:

We identified 1 192 patients with non-mCRPC from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BMI was calculated from height and weight abstracted from the medical records at the time closest to but prior to CRPC diagnosis and categorised as underweight (<21 kg/m2 ), normal weight (21-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), and obese (≥30 kg/m2 ). Competing risks regression and Cox models were used to test associations between obesity and progression to metastasis, PCSM, and ACM, accounting for confounders.

RESULTS:

Overall, 51 (4%) men were underweight, 239 (25%) were normal weight, 464 (39%) were overweight, and 438 (37%) were obese. In adjusted analysis, higher BMI was significantly associated with reduced ACM (hazard ratio [HR] 0.98, P = 0.012) but not PCSM (HR 1.00, P = 0.737) or metastases (HR 0.99, P = 0.225). Likewise, when BMI was treated as a categorical variable in adjusted models, obesity was not associated with PCSM (HR 1.11, P = 0.436) or metastases (HR 1.06, P = 0.647), but was associated with decreased ACM (HR 0.79, P = 0.016) compared to normal weight. No data were available on treatments received after CRPC diagnosis.

CONCLUSIONS:

Amongst patients with non-mCRPC obesity was associated with better overall survival. Although this result mirrors evidence from men with mCRPC, obesity was not associated with prostate cancer outcomes. Larger studies are needed to confirm these findings.

KEYWORDS:

#PCSM; #ProstateCancer; castration-resistant prostate cancer; obesity

PMID:
29521009
PMCID:
PMC5997525
[Available on 2019-07-01]
DOI:
10.1111/bju.14193
[Indexed for MEDLINE]

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