Elsevier

Urology

Volume 72, Issue 2, August 2008, Pages 406-411
Urology

Oncology
Effect of BMI on Primary Treatment of Prostate Cancer

https://doi.org/10.1016/j.urology.2007.11.032Get rights and content

Objectives

Obese patients with prostate cancer have more aggressive tumors and, in some studies, more prostate cancer-specific deaths. This study was designed to assess the relationship between body mass index (BMI) and treatment patterns of prostate cancer patients.

Methods

We identified 5041 men with clinically localized prostate cancer (T1-3a, N0M0) who received their first treatment between 1995 and 2006. We derived the odds ratios (OR) for the likelihood of receiving each type of therapy compared with radical prostatectomy by BMI categories using multinomial logistic regression. In our analysis we controlled for age at diagnosis, race/ethnicity, education level, clinical risk category, and number of co-morbidities.

Results

A total of 28.1% of patients were classified as normal BMI, 50.5% were overweight, 16.5% were obese, and 4.8% were very obese. The adjusted OR of receiving nonsurgical therapies (brachytherapy, external radiation, primary androgen deprivation, and active surveillance) increased relative to radical prostatectomy for increasing obesity (P = 0.003). Compared with the patients with normal BMI, very obese patients were more likely to receive brachytherapy (OR 1.59, 95% confidence interval [CI] 1.01 to 2.52), external radiation (OR 1.29, 95% CI 0.73 to 2.26), primary androgen therapy only (OR 1.77, 95% CI 1.12 to 2.81), and active surveillance (OR 1.06, 95% CI 0.52 to 2.17) compared with radical prostatectomy.

Conclusions

In a large cohort of American prostate cancer patients, a significant trend toward nonsurgical treatment modalities was apparent with increasing BMI.

Section snippets

Study Population

The study population consisted of patients recruited in the Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE), a national longitudinal database established in 1995 to document national trends in management as well as oncological and health-related quality of life (HRQOL) outcomes of men with all stages of biopsy-proven prostate adenocarcinoma. Patients were recruited from 40 primarily community-based urology practices (34 community-based, 3 Veteran's Administration, and 3

Results

Of the 13,124 patients enrolled in CaPSUREM as of June 2006, 5041 men met the study inclusion criteria. Table 1 presents the sociodemographic and clinical characteristics of the study cohort. The distribution of BMI categories in the study population was as follows: 28.1% of patients were classified as normal size, 50.5% were overweight, 16.5% were obese, and 4.8% were very obese. More then half of the patients (55%) underwent radical prostatectomy as an initial form of treatment for prostate

Discussion

Our findings suggest that increasing BMI independently predicts nonsurgical modes of prostate cancer treatment (brachytherapy, external beam radiation, active surveillance, and androgen deprivation) even when adjusting for multiple potential clinical and sociodemographic confounders in our statistical model. This trend implies patients, urologists, or both tend to favor nonsurgical prostate cancer treatment for increasing patient obesity.

Whereas obesity has been shown to be a risk factor for

Conclusion

Obese and very obese patients have a lower rate of surgical intervention compared with normal weight patients for the treatment of prostate cancer. Very obese patients have a significantly higher chance of receiving BT or PADT as their primary treatment. Further research on patient and physician decision-making is encouraged to elicit the underlying reasons for these trends.

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  • Cited by (0)

    This study was funded by TAP Pharmaceutical Products, Inc. P.R. Carroll is a study investigator for TAP Pharmaceuticals. C.J. Kane is a paid consultant to Intuitive Surgical and is a member of the speaker's bureau for Boehringer Ingelheim.

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