Obesity and prostate cancer: Epidemiology and clinical implications

被引:198
作者
Buschemeyer, W. Cooper, III
Freedland, Stephen J.
机构
[1] Duke Univ, Sch Med, Div Urol Surg, Dept Surg, Durham, NC 27710 USA
[2] Duke Univ, Sch Med, Duke Prostate Ctr, Durham, NC USA
[3] Duke Univ, Sch Med, Dept Pathol, Durham, NC 27706 USA
[4] Vet Adm Med Ctr, Dept Surg, Durham, NC USA
关键词
prostate cancer; obesity; body mass index; PSA; testosterone;
D O I
10.1016/j.eururo.2007.04.069
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Both obesity and prostate cancer (PCa) are epidemic in Western society. Although initial epidemiological data appeared conflicting, recent studies have clarified the association between obesity and PCa. Therefore, we sought to review the epidemiological data linking obesity and PCa with an emphasis on the clinical implications and how to improve outcomes among obese men. Methods: A PubMed search using the keywords "prostate cancer" and "obesity" was performed. Relevant articles and references were reviewed for data on the association between obesity and PCa. Results: Recent data suggest obesity is associated with reduced risk of nonaggressive disease but increased risk of aggressive disease. This observation may be explained in part by an inherent bias in our ability to detect PCa in obese men (lower PSA values and larger sized prostates, making biopsy less accurate for finding an existent cancer), which ultimately leads to increased risk of cancer recurrence after primary therapy and increased PCa mortality. Despite this detection bias potentially contributing to more aggressive cancers, multiple biological links also exist between obesity and PCa including higher estradiol, insulin, free IGF-1, and leptin levels, and lower free testosterone and adiponectin levels, all of which may promote more aggressive cancers. Conclusions: The association between obesity and PCa is complex. Emerging data suggest obesity increases the risk of aggressive cancer, while simultaneously decreasing the risk of more indolent disease. This is likely driven by both "biological" and "nonbiological" causes. Simple changes in clinical practice patterns can reduce the impact of nonbiological causes and may help improve PCa outcomes among obese men. (C) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:331 / 343
页数:13
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