A good reason for losing a bit of mass

[Guest guest]

Obesity and biochemical outcome following radical prostatectomy for organ

confined disease with negative surgical margins.

Freedland SJ, Terris MK, Presti JC Jr, Amling CL, Kane CJ, Trock B, Aronson

WJ; Search Database Study Group.

Department of Urology, s Hopkins School of Medicine, Baltimore, MD

21287-2101, USA. sfreedl1@...

PURPOSE: We have previously shown that men with a body mass index (BMI)

greater than 35 kg/m2 had higher rates of positive surgical margins and

significantly higher biochemical recurrence rates following radical

prostatectomy (RP). To determine whether the higher prostate specific

antigen (PSA) recurrence rates were due solely to the higher positive margin

rate, we examined whether obesity was an independent predictor of

biochemical failure among men with negative surgical margins.

MATERIALS AND METHODS: We examined data from 1,250 men treated with RP

between 1988 and 2003 at 5 equal access medical centers, of whom 731 had

pathologically organ confined disease and negative surgical margins.

Multivariate proportional hazards analysis was used to determine if BMI

was a significant independent predictor of biochemical recurrence.

RESULTS: Mean BMI significantly increased over time (p = 0.010). Black men

were significantly more likely to be obese than white or nonwhite-nonblack

men. After controlling for all preoperative characteristics, body mass index

was a significant predictor of biochemical failure with moderately and

severely obese men (BMI 35 kg/m2 or greater) having greater than a 4-fold

increased risk of PSA failure (p = 0.035). After controlling for the higher

pathological Gleason grades among obese men, body mass index remained a

significant predictor of biochemical failure with moderately and severely

obese men (BMI 35 kg/m2 or greater) having nearly a 4-fold increased risk

for PSA failure (p = 0.036).

CONCLUSIONS: BMI 35 kg/m2 or greater was associated with higher grade tumors

and worse outcome following RP in a cohort of men with favorable

pathological findings. Thus, surgical technique (margin status) cannot fully

explain the worse outcomes among obese men, suggesting that obesity may be

associated with a biologically more aggressive form of prostate cancer.

PMID: 15247719 [PubMed - indexed for MEDLINE]

All the best

Terry Herbert

in sunny Kalk Bay, South Africa

Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. June

04: PSA 8.35:fPSA 42% TURP

My site is at www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one knows what he doesn’t know, and the

less a man knows, the more sure he is that he knows everything. Joyce

Carey