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Review
. 2017 Jul;72(1):78-83.
doi: 10.1016/j.eururo.2016.10.011. Epub 2016 Oct 19.

Obesity and Prostate Cancer: A Focused Update on Active Surveillance, Race, and Molecular Subtyping

Adriana C Vidal  1 , Stephen J Freedland  2
Affiliations
Review

Obesity and Prostate Cancer: A Focused Update on Active Surveillance, Race, and Molecular Subtyping

Adriana C Vidal et al. Eur Urol. 2017 Jul.

Abstract

Context: In 2012, we published a detailed review on obesity and prostate cancer. Since then, new studies have brought further understanding regarding the role of obesity in selecting active surveillance candidates, and differing associations between obesity and prostate cancer as a function of race and molecular subtype of prostate cancer.

Objective: To review new manuscripts on these new concepts for which there were limited data before 2012.

Evidence acquisition: A PubMed search from July 2012 to March 2016 was performed using the terms "prostate cancer" and "obesity". Of 450 articles, we included 15 related to these three topics.

Evidence synthesis: Among men on active surveillance or candidates for active surveillance, multiple studies suggest that the risk of upgrading is higher for obese men. No study has shown long-term oncologic differences, and the risk of prostate cancer mortality remains low. One study suggested that the link between obesity and prostate cancer risk is stronger among black men; however, other studies found that obesity is correlated with aggressive disease regardless of race. Two studies found that the associations between obesity and prostate cancer (ie, fewer low-grade cancers and yet more aggressive cancers) was limited to men with TMPRSS2-ERG-positive tumors.

Conclusions: The past 4 yr has seen much new work on the obesity-prostate cancer link. If confirmed in other studies, these findings provide novel insights into not only the link between obesity and prostate cancer but also prostate cancer biology in general.

Patient summary: While their outcomes may be slightly worse, obese men with localized prostate cancer should not be discouraged from active surveillance. Early studies suggest there may be subtypes of patients in whom obesity is more strongly linked to aggressive disease.

Keywords: Active surveillance; Molecular subtype of prostate cancer; Obesity; Prostate cancer; Race.

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Conflict of interest statement

Financial disclosures: Adriana C. Vidal certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Figures

Fig. 1
Fig. 1
For the search terms obesity and prostate cancer, the number of PubMed publications has been increasing since 1991.
Fig. 2
Fig. 2
Flow diagram for the search results.
See this image and copyright information in PMC

References

    1. Allott EH, Masko EM, Freedland SJ. Obesity and prostate cancer: weighing the evidence. Eur Urol. 2013;63:800–809. - PMC - PubMed
    1. Kane CJ, Im R, Amling CL, et al. Outcomes after radical prostatectomy among men who are candidates for active surveillance: results from the SEARCH database. Urology. 2010;76:695–700. - PMC - PubMed
    1. Ploussard G, de la Taille A, Bayoud Y, et al. The risk of upstaged disease increases with body mass index in low-risk prostate cancer patients eligible for active surveillance. Eur Urol. 2012;61:356–362. - PubMed
    1. Truong M, Slezak JA, Lin CP, et al. Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer. Cancer. 2013;119:3992–4002. - PMC - PubMed
    1. de Cobelli O, Terracciano D, Tagliabue E, et al. Body mass index was associated with upstaging and upgrading in patients with low-risk prostate cancer who met the inclusion criteria for active surveillance. Urol Oncol. 2015;33:201.e1–201.e8. - PubMed

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