Originally published as JCO Early Release 10.1200/JCO.2004.03.132 on December 22 2003

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Pathologic Variables and Recurrence Rates As Related to Obesity and Race in Men With Prostate Cancer Undergoing Radical Prostatectomy

From the Naval Medical Center, San Diego, CA; Walter Reed Army Medical Center, Washington, DC; Madigan Army Medical Center, Tacoma, WA; Naval Medical Center, Portsmouth, VA; Wilford Hall Medical Center; Brooke Army Medical Center, San Antonio, TX; Eisenhower Army Medical Center, Fort Gordon, GA; Center for Prostate Disease Research, Rockville; National Naval Medical Center; Uniformed Services University of the Health Sciences, Bethesda; and Malcolm Grow Medical Center, Andrews Air Force Base, MD.

Address reprint requests to Christopher L. Amling, MD, Department of Urology, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134-5000; e-mail: clamling{at}nmcsd.med.navy.mil

PURPOSE: To determine if obesity is associated with higher prostate specific antigen recurrence rates after radical prostatectomy (RP), and to explore racial differences in body mass index (BMI) as a potential explanation for the disparity in outcome between black and white men.

PATIENTS AND METHODS: A retrospective, multi-institutional pooled analysis of 3,162 men undergoing RP was conducted at nine US military medical centers between 1987 and 2002. Patients were initially categorized as obese (BMI 30 kg/m²), overweight (BMI 25 to 30 kg/m²), or normal (BMI 25 kg/m²). For analysis, normal and overweight groups were combined (BMI < 30 kg/m²) and compared with the obese group (BMI 30 kg/m²) with regard to biochemical recurrence (prostate-specific antigen 0.2 ng/mL) after RP.

RESULTS: Of 3,162 patients, 600 (19.0%) were obese and 2,562 (81%) were not obese. BMI was an independent predictor of higher Gleason grade cancer (P < .001) and was associated with a higher risk of biochemical recurrence (P = .027). Blacks had higher BMI (P < .001) and higher recurrence rates (P = .003) than whites. Both BMI (P = .028) and black race (P = .002) predicted higher prostate specific antigen recurrence rates. In multivariate analysis of race, BMI, and pathologic factors, black race (P = .021) remained a significant independent predictor of recurrence.

CONCLUSION: Obesity is associated with higher grade cancer and higher recurrence rates after RP. Black men have higher recurrence rates and greater BMI than white men. These findings support the hypothesis that obesity is associated with progression of latent to clinically significant prostate cancer (PC) and suggest that BMI may account, in part, for the racial variability in PC risk.

Supported by the Center for Prostate Disease Research, a Department of Defense program of the Uniformed Services University of the Health Sciences funded by the US Army Medical Research and Materiel Command.

The opinions and assertions contained herein are the views of the authors and are not to be construed as reflecting the views of the US Navy, Army, Air Force, or Department of Defense.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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