A new study on the association between obesity and prostate cancer entitled “Obesity Is Associated with Risk of Progression for Low-risk Prostate Cancers Managed Expectantly” was published in the European Urology Journal by Dr. Neil E. Fleshner’group from Division of Urology, Department of Surgery, Princess Margaret Hospital, University Health Network, Ontario, Canada.
The correlation between obesity and prostate cancer (PCa) occurrence has been a controversial issue, however, several epidemiological studies have shown the existence of multiple associations between obesity and advanced Pca, biochemical recurrence and mortality associated this malignancy.
Obesity has been linked to a series of biological alterations, such as hyperinsulinemia, changes in the levels of adipokine, vascular endothelial growth factor and sex hormones, that have a negative impact in cancer risk and progression. In addition, obesity can have deleterious effects in prostate biopsies and/or render its detection challenging after biopsy in several ways, such as diluting the serum prostate-specific antigen (PSA), hampering digital rectal examination (DRE) and increasing prostate size.
The team evaluated if obesity was associated with an increased risk of progression in a group of men undergoing active surveillance (AS), which involved direct monitoring of low-risk prostate cancer. Only if there were signs of progression would these subjects begin active treatment.
In the study, 565 men were followed on average for 48 months, with the results demonstrating that 124 (22%) were obese and pathologic, with therapeutic progression occurring, respectively, in 168 men (30%) and 172 men (30%). After confirmatory biopsy, obesity was associated with a greater probability of pathologic progression and therapeutic progression.
The results of this study are consistent with previous reported epidemiological studies that have demonstrated a correlation between obesity and advanced Pca. However other factors like individual genetic susceptibility, tumor profile, diet, exercise, and metabolic syndrome that in this retrospective observational study could not be accounted, which would affect the level of the association between obesity and PCa outcomes. This study also showed that in obese men, the risks of under- and over-treatments are increased. Therefore active surveillance (AS) should be used in obese men with low-risk PCa together with a tight monitoring.
Overall, the team concluded that obesity correlates with an increased risk of PCa progression during AS. However, additional research is necessary to assess if diet and exercise can diminish the risk of cancer progression while on AS.
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