%0 Journal Article
%T The Effect of Obesity and Diabetes on Intermediate to High Grade Prostate Cancer Patients Treated with Radical Prostatectomy
%A Emma H. Ramahi
%A Katherine C. Ansley
%A Gregory P. Swanson
%A Fei Du
%A Joseph W. Basler
%J Open Journal of Urology
%P 20-27
%@ 2160-5629
%D 2012
%I Scientific Research Publishing
%R 10.4236/oju.2012.21005
%X Aims: The relationships between obesity, diabetes and prostate cancer are unclear. A retrospective study was performed to determine the effects of body mass index (BMI) and diabetes on patients with intermediate to high grade prostate cancer treated with radical prostatectomy. Methods: We reviewed 582 patients with Gleason score ¡Ý 7 non-metastatic prostate cancer treated with radical prostatectomy. Patients were stratified by BMI. End points were biochemical failure free survival (BFFS), overall survival (OS), and cancer specific survival (CSS). Results: Mean pre-treatment PSA decreased with increasing BMI (12.5, 7.6, 7.8 and 5.3 ng/mL with BMI < 25, 25 - 30, 30 - 35, and > 35, respectively; p < 0.001). There was no significant difference in BFFS, OS or CSS between diabetic and non-diabetic patients. After adjusting for potential confounders (age, Gleason score and pre-treatment PSA), patients with higher BMI experienced biochemical failure more often with hazard ratios 1.87 (1.15, 3.04; p = 0.01), 2.23 (1.39, 3.56; p < 0.001), and 2.5 (1.22, 5.12; p = 0.01) for BMI 25 - 30, 30 - 35 and > 35, respectively. However, for overall mortality the adjusted hazard ratio was 0.39 (0.18, 0.82; p = 0.01) for overweight patients (BMI 25 - 30) compared to patients with a BMI in the normal range. Patients with a BMI of 30 - 35 and > 35 had increased rates of positive margins than those with a BMI of 25 - 30 or < 25 (41.4% and 45.5% versus 28.9% and 33.3%, respectively; p = 0.02). Patients with higher BMI than 25 had higher biochemical recurrence rate (25 - 30 HR 2; 30 - 35 HR 1.97 and > 35 2.04) on multivariate analysis, margin positivity alone was not a significant factor. Conclusions: Patients with increasing BMI tend to have a lower PSA at diagnosis but are more likely to have biochemical failure after radical prostatectomy. In our cohort, this was not due to the increased incidence of positive margins. Having diabetes had no effect.
%K Obesity
%K Diabetes Mellitus
%K Prostatectomy
%K Prostatic Neoplasms
%K Therapy
%K Treatment Outcomes
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=17797