1. In men with low-risk prostate cancer undergoing active surveillance, obesity (BMI>30) was significantly associated with pathologic and therapeutic progression after the first confirmatory biopsy.
Evidence Rating Level: 3 (Average)
Study Rundown: Obesity has previously been associated with increased risk of advanced prostate cancer (PCa), risk of biochemical occurrence, and PCa specific mortality. However, the effect of obesity on the progression of low-risk PCa (Gleason score <6) is unclear. The authors of this paper retrospectively reviewed 152 normal and 413 overweight/obese men undergoing active surveillance (AS) for low-grade PCa for pathological or therapeutic progression of disease. After a median follow-up of 48 months, the study demonstrated that increased BMI categories are significantly associated with higher rate of pathological and therapeutic progression post-confirmatory biopsy. The results of this study suggests increased vigilance is needed in monitoring obese patients in AS. The strength of this article is the large sample size for a AS cohort, as well as the consistent biopsy protocol for men with normal and elevated BMI. However, the study is limited by the retrospective design and the inability to account for various lifestyle confounders (i.e. diet, exercise).
Relevant Reading: Obesity and Prostate Cancer: Weighing the Evidence
In-Depth [retrospective review]: This retrospective review analyzed the PSA and biopsy results of 565 men with low-grade PCa followed by AS. The primary outcomes were pathological (no longer meeting criteria for low-risk) or therapeutic (intent to initiate definitive treatment) progression of PCa. All patients were provided with a confirmatory biopsy after the initial diagnosis (median time from initial biopsy: 12 months). Cox proportional hazard models did not demonstrate significant association between BMI and PCa progression at the confirmatory biopsy (HR: 1.1; 95% CI: 0.8-1.5, p=0.6). However, BMI was significantly associated with PCa pathological and therapeutic progression post-confirmatory biopsy (above). Higher BMI was also associated with higher grade (p<0.05) and volume (p<0.03) progression post confirmatory biopsy.
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