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OBESITY LINKED TO PROSTRATE CANCER AGGRESSIVENESS, RECURRENCE

OBESITY increases the risk for higher grade prostrate cancer and higher recurrence rates after radical prostactectomy, two research groups report. Both propose that obesity may at least partially explain the racial disparity in prostate cancer outcomes.

Epidemiological studies have been inconsistent in showing a relationship between obesity and prostate cancer, the two teams note in a December 22 online release from the Journal of Clinical Oncology. In fact, obesity sees to be a stronger risk factor for dying from prostate cancer mortality than developing it in the first place.

Dr. Christopher L. Amling, at the Naval Medical Centre in San Diego, and colleagues evaluated data for 3162 patients who underwent radical prostatectomy - surgical removal between 1987 and 2002, as documented in the Centre for Prostrate Disease Research database.

Nineteen per cent of the cohort was obese, as defined by a body mass index of 30 kg/m2 or above. Obesity was associated with a median prostate specific antigen (PSA) of 6.3 versus 6.1 in the non-obese group, and significantly more advanced tumor development and higher biochemical recurrence rate - relapse identified by increasing PSA levels.

Compared with white men, black men presented with cancer at younger age and with tumors of higher grade and stage. They were also significantly more obese

Meanwhile, the Shared Equal Access Regional Cancer Hospital (SEARCH) database Study Group, led by Dr. Stephen J. Freedland at Johns Hopkins Schools of Medicine in Baltimore, also reports that black men treated for prostate cancer had significantly higher mean BMI than white men.

Included in the analysis were 1752 patients treated with radical prostatectomy between 1988 and 2002. Of note, the incidence of obesity approximately doubled over the last decade of the study.

Obese patients were younger and had higher biopsy and pathologic Gleason scores, Dr. Freedland and associates report. The risk for PSA failure was significantly increased for those with severe obesity.

"Given the disproportionate burden of (prostate cancer) on black men, programmes targeted to control obesity in the black community may be warranted," they suggest.

In an editorial, Dr. Alfred I. Neugut and colleagues at Columbia University in New York note that obesity, while not a consistent risk for prostate cancer incidence, is consistently associated with prostate cancer mortality.

"In light of the increasing worldwide incidence of obesity, the identification of obesity as a risk factor for aggressive prostate cancer is important because it may be one of the few modifiable risk factors for prostate cancer," they maintain.

Meanwhile, two research groups have reported that obesity increases the risk for higher grade prostate cancer and higher recurrence rates after radical prostatectomy, removal of the whole prostate gland. (High grades may be good in school but they are not with cancer. Higher grade cancers are more advanced and aggressive).

Both research groups propose that obesity may in part explain the black-white difference in prostate cancer outcomes. Compared with white men, black men are diagnosed with prostate cancer at a younger age and have tumors of higher grade and stage. They are also significantly more obese. (Black men have a 1.6-fold higher chance of dying of prostate cancer than do white men).

This new research is important and timely. A week ago United States Secretary of State, Collin Powell underwent surgery for prostate cancer. Fortunately, Powell is not obese.

Medical tests have shown that Powell's cancer did not spread beyond the prostate so his prognosis (outlook) should, we hope, be very good.

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