Obesity may interfere with prostate cancer screening

[Guest guest]

http://in.reuters.com/article/health/idINSIB80429320080628

Obesity

may

interfere with prostate cancer screen

Reuters India

- Mumbai,India

" The current

data, " the researchers conclude, " suggest that the PSA cut-points

used to recommend biopsy need to be adjusted for the degree of obesity. "

Thank you Jack

[Guest guest]

Obesity? Hmm ….this Reuters report

seems to refer to the study posted below where PSA numbers in Japan were

compared with PSA numbers in the USA – anyone spot any potential anomalies

in that kind of comparison?

But that isn’t the main issue that

sprang to mind when I read this – after all there are US studies of US

men, one of which has this conclusion <snip> Across the study population, increased BMI [body

Mass Index] was significantly inversely associated with lower PSA. Based on a

theoretical model in which increased plasma volume in the obese dilutes PSA

levels we propose new cut-points for a positive screening test. <snip> The

theoretical model referred to <snip> ….. accurately predicted

observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal

weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml

in morbidly obese men. <snip> A curious feature of this study was that changes

in the BMI of the men in the study were not associated with changes in PSA

levels. Huh? So once you’re obese/overweight, your PSA remains at a lower

level than normal even when you cease to be obese/overweight? How Can that be?

But to get back to my

meandering thoughts. I was very surprised to find last year that I fell into

the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s

more, to get to the median level of ‘normal’ weight I would have to

lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very

depressing, until I happened to go to the footy (Australian Rules Football) and

read up on some of the player’s vital statistics. Many of them are obese

too, by the BMI calculation, yet some run the equivalent of a marathon

during the course of a game. Checking on other codes – rugby union/rugby

league - I found the same thing. These elite athletes were obese, just like me.

Well, not just like me to be fair, they were fit and muscular and I wasn’t.

I have lost a good deal of weight – I was concerned about possible weight

gain following commencement of ADT (Androgen Deprivation Therapy) – and I

am still overweight, but not so concerned about that.

But back to the study

conclusions mentioned above (and in the Reuters report <snip> Obese

men have lower PSA values likely due to excess blood volume, " Freedland,

the senior investigator on the study, told Reuters Health. <snip>) that

it is the increased plasma/blood volume that lowers the PSA, then surely

tall, large non-obese men would have lower than PSA numbers than less tall,

smaller non-obese men? After all they probably have a greater

blood/plasma volume?

My doesn’t it get

complicated? And is there really anything to be learned from these studies? Do

they really help newly diagnosed men; or men who are choosing treatment or men

who have had treatment or…..do they just waste bandwidth?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

Urology. 2008 May 30. [Epub ahead of

print]

Inverse

Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy

Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006.

Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y,

Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S.

Department of Nephro-Urology, Nagoya City

University Graduate School of Medical Sciences, Nagoya, Japan; Department of

Public Health, Nagoya City University Graduate School of Medical Sciences,

Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan.

OBJECTIVES: To confirm an inverse

relationship between obesity and serum prostate-specific antigen (PSA) levels

in Japanese men with a smaller body mass index (BMI) than white and

African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men

aged >20 years who visited our medical center for a health checkup from

January 2004 to December 2006. The men were divided into 6 groups by age

decade, and the BMI was categorized into 5 groups. The body fat percentage

(BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2)

test was used to check for trends in proportions of subjects with abnormal PSA

values for each cutoff point (2.5 and 4.0 ng/mL) in these groups. The

relationships between the PSA levels and BMI or BFP were examined using multivariate

analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2

kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with

an abnormal PSA value increased significantly with age (P for trend <

..0001); however, no trends were found across the BMI or BFP categories. The

geometric mean PSA level increased significantly with age (P for linear trend

< .0001) and decreased with BMI and BFP categories (P for linear trend =

..001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings

have demonstrated an inverse relationship between obesity and PSA levels even

in Japanese men with a low prevalence of obesity, such as was previously

reported for American men. Therefore, in prostate cancer screening, obesity,

which can affect the accuracy of PSA testing, independent of race and

ethnicity, should be taken into account.

PMID: 18514773 [PubMed - as supplied by

publisher]

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Saturday, 28 June 2008 11:55

PM

To: ProstateCancerSupport ;

ProstateCancerCommunityLeaders ; NASPCC ;

VAPCACOALITION

Subject:

Obesity may interfere with prostate cancer screening

http://in.reuters.com/article/health/idINSIB80429320080628

Obesity

may

interfere with prostate cancer screen

Reuters India

- Mumbai,India

" The current

data, " the researchers conclude, " suggest that the PSA cut-points

used to recommend biopsy need to be adjusted for the degree of obesity. "

Thank you Jack

[Guest guest]

Obesity? Hmm ….this Reuters report

seems to refer to the study posted below where PSA numbers in Japan were

compared with PSA numbers in the USA – anyone spot any potential anomalies

in that kind of comparison?

But that isn’t the main issue that

sprang to mind when I read this – after all there are US studies of US

men, one of which has this conclusion <snip> Across the study population, increased BMI [body

Mass Index] was significantly inversely associated with lower PSA. Based on a

theoretical model in which increased plasma volume in the obese dilutes PSA

levels we propose new cut-points for a positive screening test. <snip> The

theoretical model referred to <snip> ….. accurately predicted

observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal

weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml

in morbidly obese men. <snip> A curious feature of this study was that changes

in the BMI of the men in the study were not associated with changes in PSA

levels. Huh? So once you’re obese/overweight, your PSA remains at a lower

level than normal even when you cease to be obese/overweight? How Can that be?

But to get back to my

meandering thoughts. I was very surprised to find last year that I fell into

the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s

more, to get to the median level of ‘normal’ weight I would have to

lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very

depressing, until I happened to go to the footy (Australian Rules Football) and

read up on some of the player’s vital statistics. Many of them are obese

too, by the BMI calculation, yet some run the equivalent of a marathon

during the course of a game. Checking on other codes – rugby union/rugby

league - I found the same thing. These elite athletes were obese, just like me.

Well, not just like me to be fair, they were fit and muscular and I wasn’t.

I have lost a good deal of weight – I was concerned about possible weight

gain following commencement of ADT (Androgen Deprivation Therapy) – and I

am still overweight, but not so concerned about that.

But back to the study

conclusions mentioned above (and in the Reuters report <snip> Obese

men have lower PSA values likely due to excess blood volume, " Freedland,

the senior investigator on the study, told Reuters Health. <snip>) that

it is the increased plasma/blood volume that lowers the PSA, then surely

tall, large non-obese men would have lower than PSA numbers than less tall,

smaller non-obese men? After all they probably have a greater

blood/plasma volume?

My doesn’t it get

complicated? And is there really anything to be learned from these studies? Do

they really help newly diagnosed men; or men who are choosing treatment or men

who have had treatment or…..do they just waste bandwidth?

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

Urology. 2008 May 30. [Epub ahead of

print]

Inverse

Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy

Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006.

Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y,

Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S.

Department of Nephro-Urology, Nagoya City

University Graduate School of Medical Sciences, Nagoya, Japan; Department of

Public Health, Nagoya City University Graduate School of Medical Sciences,

Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan.

OBJECTIVES: To confirm an inverse

relationship between obesity and serum prostate-specific antigen (PSA) levels

in Japanese men with a smaller body mass index (BMI) than white and

African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men

aged >20 years who visited our medical center for a health checkup from

January 2004 to December 2006. The men were divided into 6 groups by age

decade, and the BMI was categorized into 5 groups. The body fat percentage

(BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2)

test was used to check for trends in proportions of subjects with abnormal PSA

values for each cutoff point (2.5 and 4.0 ng/mL) in these groups. The

relationships between the PSA levels and BMI or BFP were examined using multivariate

analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2

kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with

an abnormal PSA value increased significantly with age (P for trend <

..0001); however, no trends were found across the BMI or BFP categories. The

geometric mean PSA level increased significantly with age (P for linear trend

< .0001) and decreased with BMI and BFP categories (P for linear trend =

..001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings

have demonstrated an inverse relationship between obesity and PSA levels even

in Japanese men with a low prevalence of obesity, such as was previously

reported for American men. Therefore, in prostate cancer screening, obesity,

which can affect the accuracy of PSA testing, independent of race and

ethnicity, should be taken into account.

PMID: 18514773 [PubMed - as supplied by

publisher]

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy Meade

Sent: Saturday, 28 June 2008 11:55

PM

To: ProstateCancerSupport ;

ProstateCancerCommunityLeaders ; NASPCC ;

VAPCACOALITION

Subject:

Obesity may interfere with prostate cancer screening

http://in.reuters.com/article/health/idINSIB80429320080628

Obesity

may

interfere with prostate cancer screen

Reuters India

- Mumbai,India

" The current

data, " the researchers conclude, " suggest that the PSA cut-points

used to recommend biopsy need to be adjusted for the degree of obesity. "

Thank you Jack

[Guest guest]

Hi Terry;

You should have been an author!

I always enjoy the way you tell a story, and bring to our attention some of the ridiculous things that some of these studies supposedly show.

A lot of these so called studies just add more confusion (if that's possible), to an already very confusing disease, adding more angst to people who absolutely don't need any more!

Keep up the good work Terry, and keep writing the way you do, I for one, really enjoy it.

Bob G

RE: Obesity may interfere with prostate cancer screening

Obesity? Hmm ….this Reuters report seems to refer to the study posted below where PSA numbers in Japan were compared with PSA numbers in the USA – anyone spot any potential anomalies in that kind of comparison?

But that isn’t the main issue that sprang to mind when I read this – after all there are US studies of US men, one of which has this conclusion <snip> Across the study population, increased BMI [body Mass Index] was significantly inversely associated with lower PSA. Based on a theoretical model in which increased plasma volume in the obese dilutes PSA levels we propose new cut-points for a positive screening test. <snip> The theoretical model referred to <snip> ….. accurately predicted observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml in morbidly obese men. <snip> A curious feature of this study was that changes in the BMI of the men in the study were not associated with changes in PSA levels. Huh? So once you’re obese/overweight, your PSA remains at a lower level than normal even when you cease to be obese/overweight? How Can that be?

But to get back to my meandering thoughts. I was very surprised to find last year that I fell into the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s more, to get to the median level of ‘normal’ weight I would have to lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very depressing, until I happened to go to the footy (Australian Rules Football) and read up on some of the player’s vital statistics. Many of them are obese too, by the BMI calculation, yet some run the equivalent of a marathon during the course of a game. Checking on other codes – rugby union/rugby league - I found the same thing. These elite athletes were obese, just like me. Well, not just like me to be fair, they were fit and muscular and I wasn’t. I have lost a good deal of weight – I was concerned about possible weight gain following commencement of ADT (Androgen Deprivation Therapy) – and I am still overweight, but not so concerned about that.

But back to the study conclusions mentioned above (and in the Reuters report <snip> Obese men have lower PSA values likely due to excess blood volume," Freedland, the senior investigator on the study, told Reuters Health. <snip>) that it is the increased plasma/blood volume that lowers the PSA, then surely tall, large non-obese men would have lower than PSA numbers than less tall, smaller non-obese men? After all they probably have a greater blood/plasma volume?

My doesn’t it get complicated? And is there really anything to be learned from these studies? Do they really help newly diagnosed men; or men who are choosing treatment or men who have had treatment or…..do they just waste bandwidth?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

Urology. 2008 May 30. [Epub ahead of print]

Inverse Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006.

Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y, Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S.

Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan.

OBJECTIVES: To confirm an inverse relationship between obesity and serum prostate-specific antigen (PSA) levels in Japanese men with a smaller body mass index (BMI) than white and African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men aged >20 years who visited our medical center for a health checkup from January 2004 to December 2006. The men were divided into 6 groups by age decade, and the BMI was categorized into 5 groups. The body fat percentage (BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2) test was used to check for trends in proportions of subjects with abnormal PSA values for each cutoff point (2.5 and 4.0 ng/mL) in these groups. The relationships between the PSA levels and BMI or BFP were examined using multivariate analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2 kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with an abnormal PSA value increased significantly with age (P for trend < .0001); however, no trends were found across the BMI or BFP categories. The geometric mean PSA level increased significantly with age (P for linear trend < .0001) and decreased with BMI and BFP categories (P for linear trend = .001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings have demonstrated an inverse relationship between obesity and PSA levels even in Japanese men with a low prevalence of obesity, such as was previously reported for American men. Therefore, in prostate cancer screening, obesity, which can affect the accuracy of PSA testing, independent of race and ethnicity, should be taken into account.

PMID: 18514773 [PubMed - as supplied by publisher]

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy MeadeSent: Saturday, 28 June 2008 11:55 PMTo: ProstateCancerSupport ; ProstateCancerCommunityLeaders ; NASPCC ; VAPCACOALITION Subject: Obesity may interfere with prostate cancer screening

http://in.reuters.com/article/health/idINSIB80429320080628Obesity may interfere with prostate cancer screenReuters India - Mumbai,India"The current data," the researchers conclude, "suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity."

Thank you Jack

No virus found in this incoming message.Checked by AVG. Version: 7.5.524 / Virus Database: 270.4.3/1524 - Release Date: 6/28/08 7:42 PM

[Guest guest]

Hi Terry;

You should have been an author!

I always enjoy the way you tell a story, and bring to our attention some of the ridiculous things that some of these studies supposedly show.

A lot of these so called studies just add more confusion (if that's possible), to an already very confusing disease, adding more angst to people who absolutely don't need any more!

Keep up the good work Terry, and keep writing the way you do, I for one, really enjoy it.

Bob G

RE: Obesity may interfere with prostate cancer screening

Obesity? Hmm ….this Reuters report seems to refer to the study posted below where PSA numbers in Japan were compared with PSA numbers in the USA – anyone spot any potential anomalies in that kind of comparison?

But that isn’t the main issue that sprang to mind when I read this – after all there are US studies of US men, one of which has this conclusion <snip> Across the study population, increased BMI [body Mass Index] was significantly inversely associated with lower PSA. Based on a theoretical model in which increased plasma volume in the obese dilutes PSA levels we propose new cut-points for a positive screening test. <snip> The theoretical model referred to <snip> ….. accurately predicted observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml in morbidly obese men. <snip> A curious feature of this study was that changes in the BMI of the men in the study were not associated with changes in PSA levels. Huh? So once you’re obese/overweight, your PSA remains at a lower level than normal even when you cease to be obese/overweight? How Can that be?

But to get back to my meandering thoughts. I was very surprised to find last year that I fell into the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s more, to get to the median level of ‘normal’ weight I would have to lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very depressing, until I happened to go to the footy (Australian Rules Football) and read up on some of the player’s vital statistics. Many of them are obese too, by the BMI calculation, yet some run the equivalent of a marathon during the course of a game. Checking on other codes – rugby union/rugby league - I found the same thing. These elite athletes were obese, just like me. Well, not just like me to be fair, they were fit and muscular and I wasn’t. I have lost a good deal of weight – I was concerned about possible weight gain following commencement of ADT (Androgen Deprivation Therapy) – and I am still overweight, but not so concerned about that.

But back to the study conclusions mentioned above (and in the Reuters report <snip> Obese men have lower PSA values likely due to excess blood volume," Freedland, the senior investigator on the study, told Reuters Health. <snip>) that it is the increased plasma/blood volume that lowers the PSA, then surely tall, large non-obese men would have lower than PSA numbers than less tall, smaller non-obese men? After all they probably have a greater blood/plasma volume?

My doesn’t it get complicated? And is there really anything to be learned from these studies? Do they really help newly diagnosed men; or men who are choosing treatment or men who have had treatment or…..do they just waste bandwidth?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

Urology. 2008 May 30. [Epub ahead of print]

Inverse Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006.

Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y, Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S.

Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan.

OBJECTIVES: To confirm an inverse relationship between obesity and serum prostate-specific antigen (PSA) levels in Japanese men with a smaller body mass index (BMI) than white and African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men aged >20 years who visited our medical center for a health checkup from January 2004 to December 2006. The men were divided into 6 groups by age decade, and the BMI was categorized into 5 groups. The body fat percentage (BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2) test was used to check for trends in proportions of subjects with abnormal PSA values for each cutoff point (2.5 and 4.0 ng/mL) in these groups. The relationships between the PSA levels and BMI or BFP were examined using multivariate analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2 kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with an abnormal PSA value increased significantly with age (P for trend < .0001); however, no trends were found across the BMI or BFP categories. The geometric mean PSA level increased significantly with age (P for linear trend < .0001) and decreased with BMI and BFP categories (P for linear trend = .001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings have demonstrated an inverse relationship between obesity and PSA levels even in Japanese men with a low prevalence of obesity, such as was previously reported for American men. Therefore, in prostate cancer screening, obesity, which can affect the accuracy of PSA testing, independent of race and ethnicity, should be taken into account.

PMID: 18514773 [PubMed - as supplied by publisher]

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy MeadeSent: Saturday, 28 June 2008 11:55 PMTo: ProstateCancerSupport ; ProstateCancerCommunityLeaders ; NASPCC ; VAPCACOALITION Subject: Obesity may interfere with prostate cancer screening

http://in.reuters.com/article/health/idINSIB80429320080628Obesity may interfere with prostate cancer screenReuters India - Mumbai,India"The current data," the researchers conclude, "suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity."

Thank you Jack

No virus found in this incoming message.Checked by AVG. Version: 7.5.524 / Virus Database: 270.4.3/1524 - Release Date: 6/28/08 7:42 PM

[Guest guest]

Hi Terry;

You should have been an author!

I always enjoy the way you tell a story, and bring to our attention some of the ridiculous things that some of these studies supposedly show.

A lot of these so called studies just add more confusion (if that's possible), to an already very confusing disease, adding more angst to people who absolutely don't need any more!

Keep up the good work Terry, and keep writing the way you do, I for one, really enjoy it.

Bob G

RE: Obesity may interfere with prostate cancer screening

Obesity? Hmm ….this Reuters report seems to refer to the study posted below where PSA numbers in Japan were compared with PSA numbers in the USA – anyone spot any potential anomalies in that kind of comparison?

But that isn’t the main issue that sprang to mind when I read this – after all there are US studies of US men, one of which has this conclusion <snip> Across the study population, increased BMI [body Mass Index] was significantly inversely associated with lower PSA. Based on a theoretical model in which increased plasma volume in the obese dilutes PSA levels we propose new cut-points for a positive screening test. <snip> The theoretical model referred to <snip> ….. accurately predicted observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml in morbidly obese men. <snip> A curious feature of this study was that changes in the BMI of the men in the study were not associated with changes in PSA levels. Huh? So once you’re obese/overweight, your PSA remains at a lower level than normal even when you cease to be obese/overweight? How Can that be?

But to get back to my meandering thoughts. I was very surprised to find last year that I fell into the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s more, to get to the median level of ‘normal’ weight I would have to lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very depressing, until I happened to go to the footy (Australian Rules Football) and read up on some of the player’s vital statistics. Many of them are obese too, by the BMI calculation, yet some run the equivalent of a marathon during the course of a game. Checking on other codes – rugby union/rugby league - I found the same thing. These elite athletes were obese, just like me. Well, not just like me to be fair, they were fit and muscular and I wasn’t. I have lost a good deal of weight – I was concerned about possible weight gain following commencement of ADT (Androgen Deprivation Therapy) – and I am still overweight, but not so concerned about that.

But back to the study conclusions mentioned above (and in the Reuters report <snip> Obese men have lower PSA values likely due to excess blood volume," Freedland, the senior investigator on the study, told Reuters Health. <snip>) that it is the increased plasma/blood volume that lowers the PSA, then surely tall, large non-obese men would have lower than PSA numbers than less tall, smaller non-obese men? After all they probably have a greater blood/plasma volume?

My doesn’t it get complicated? And is there really anything to be learned from these studies? Do they really help newly diagnosed men; or men who are choosing treatment or men who have had treatment or…..do they just waste bandwidth?

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

Urology. 2008 May 30. [Epub ahead of print]

Inverse Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006.

Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y, Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S.

Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan.

OBJECTIVES: To confirm an inverse relationship between obesity and serum prostate-specific antigen (PSA) levels in Japanese men with a smaller body mass index (BMI) than white and African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men aged >20 years who visited our medical center for a health checkup from January 2004 to December 2006. The men were divided into 6 groups by age decade, and the BMI was categorized into 5 groups. The body fat percentage (BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2) test was used to check for trends in proportions of subjects with abnormal PSA values for each cutoff point (2.5 and 4.0 ng/mL) in these groups. The relationships between the PSA levels and BMI or BFP were examined using multivariate analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2 kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with an abnormal PSA value increased significantly with age (P for trend < .0001); however, no trends were found across the BMI or BFP categories. The geometric mean PSA level increased significantly with age (P for linear trend < .0001) and decreased with BMI and BFP categories (P for linear trend = .001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings have demonstrated an inverse relationship between obesity and PSA levels even in Japanese men with a low prevalence of obesity, such as was previously reported for American men. Therefore, in prostate cancer screening, obesity, which can affect the accuracy of PSA testing, independent of race and ethnicity, should be taken into account.

PMID: 18514773 [PubMed - as supplied by publisher]

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Kathy MeadeSent: Saturday, 28 June 2008 11:55 PMTo: ProstateCancerSupport ; ProstateCancerCommunityLeaders ; NASPCC ; VAPCACOALITION Subject: Obesity may interfere with prostate cancer screening

http://in.reuters.com/article/health/idINSIB80429320080628Obesity may interfere with prostate cancer screenReuters India - Mumbai,India"The current data," the researchers conclude, "suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity."

Thank you Jack

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[Guest guest]

This BMI obsession on the part of medicos rooted in the past needs killing off. BMI is NOT an measure of obesity. You need to look at chest, waist and hip measurements. Is the guy apple shaped? - that's bad. Is he inverted pear shaped? - that's probably OK. Much better to look at body fat %, whatever the shape. I say with feeling as a bloke built like a rugby forward (which I was as a scholboy) but not fat (when I was checked 10-12 years ago, I was off the scale in terms of very low fat) but in BMI terms I was over 30 on the index. Yet I was playing cricket twice a week in the summer and (field) hockey once or twice also in the winter. I was never fitter than in my fifties. I used to joke about being "heavy boned", but it isn't that. Like Terry, I am still classed as obese in BMI tables but it obviously isn't so when you see me. I put on weight on first going on Zoladex but I think I've

conquered that now and am back to the "fighting weight" of my fifties. Every time I see a hospital or GP data collection sheet attempting to calculate my BMI and assign some meaning to this, I object and tell them to look at a better measure - for example, body fat %. Big is NOT obese. Rant over. Until they deal with PSA and body fat % I don't think the stats will mean a thing. Terry, I sign off as another elite athlete.... Terry Herbert wrote: Obesity? Hmm ….this Reuters report seems to refer to the study posted below where PSA numbers in Japan were compared with PSA numbers in the USA – anyone spot any potential anomalies in that kind of comparison? But that isn’t the main issue that sprang to mind when I read this – after all there are US studies of US men, one of which has this conclusion <snip> Across the study population, increased BMI [body Mass Index] was significantly inversely associated with lower PSA. Based on a theoretical model in which increased plasma volume in the obese dilutes PSA levels we propose new cut-points for a positive screening test. <snip> The theoretical model referred to <snip> ….. accurately predicted observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml in morbidly obese men. <snip> A curious feature of this study was that changes in the BMI of the men in the study were not associated with changes in PSA levels. Huh? So once you’re obese/overweight, your PSA remains at a lower level than normal even when you cease to be obese/overweight? How Can that be? But to get back to my meandering thoughts. I was very surprised to find last year that I fell into the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s more, to get to the median level of ‘normal’ weight I would have to lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very depressing, until I happened to go to the footy (Australian Rules Football) and read up on some of the player’s vital

statistics. Many of them are obese too, by the BMI calculation, yet some run the equivalent of a marathon during the course of a game. Checking on other codes – rugby union/rugby league - I found the same thing. These elite athletes were obese, just like me. Well, not just like me to be fair, they were fit and muscular and I wasn’t. I have lost a good deal of weight – I was concerned about possible weight gain following commencement of ADT (Androgen Deprivation Therapy) – and I am still overweight, but not so concerned about that. But back to the study conclusions mentioned above (and in the Reuters report <snip> Obese men have lower PSA

values likely due to excess blood volume," Freedland, the senior investigator on the study, told Reuters Health. <snip>) that it is the increased plasma/blood volume that lowers the PSA, then surely tall, large non-obese men would have lower than PSA numbers than less tall, smaller non-obese men? After all they probably have a greater blood/plasma volume? My doesn’t it get complicated? And is there really anything to be learned from these studies? Do they really help newly diagnosed men; or men who are choosing treatment or men who have had treatment or…..do they just waste bandwidth? All the best Terry Herbert I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then. My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data" Urology. 2008 May 30. [Epub ahead of print] Inverse Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006. Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y, Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S. Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of

Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan. OBJECTIVES: To confirm an inverse relationship between obesity and serum prostate-specific antigen (PSA) levels in Japanese men with a smaller body mass index (BMI) than white and African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men aged >20 years who visited our medical center for a health checkup from January 2004 to December 2006. The men were divided into 6 groups by age decade, and the BMI was categorized into 5 groups. The body fat percentage (BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2) test was used to check for trends in proportions of subjects with abnormal PSA values for each cutoff point (2.5 and 4.0 ng/mL) in

these groups. The relationships between the PSA levels and BMI or BFP were examined using multivariate analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2 kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with an abnormal PSA value increased significantly with age (P for trend < .0001); however, no trends were found across the BMI or BFP categories. The geometric mean PSA level increased significantly with age (P for linear trend < .0001) and decreased with BMI and BFP categories (P for linear trend = .001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings have demonstrated an inverse relationship between obesity and PSA levels even in Japanese men with a low prevalence of obesity, such as was previously reported for American men. Therefore, in prostate cancer screening, obesity, which can affect the accuracy of PSA testing, independent of race and ethnicity, should be taken into

account. PMID: 18514773 [PubMed - as supplied by publisher] From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of

Kathy MeadeSent: Saturday, 28 June 2008 11:55 PMTo: ProstateCancerSupport ; ProstateCancerCommunityLeaders ; NASPCC ; VAPCACOALITION Subject: Obesity may interfere with prostate cancer screening http://in.reuters.com/article/health/idINSIB80429320080628Obesity may interfere with prostate cancer screenReuters India - Mumbai,India"The current data," the researchers conclude, "suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity." Thank you Jack

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[Guest guest]

This BMI obsession on the part of medicos rooted in the past needs killing off. BMI is NOT an measure of obesity. You need to look at chest, waist and hip measurements. Is the guy apple shaped? - that's bad. Is he inverted pear shaped? - that's probably OK. Much better to look at body fat %, whatever the shape. I say with feeling as a bloke built like a rugby forward (which I was as a scholboy) but not fat (when I was checked 10-12 years ago, I was off the scale in terms of very low fat) but in BMI terms I was over 30 on the index. Yet I was playing cricket twice a week in the summer and (field) hockey once or twice also in the winter. I was never fitter than in my fifties. I used to joke about being "heavy boned", but it isn't that. Like Terry, I am still classed as obese in BMI tables but it obviously isn't so when you see me. I put on weight on first going on Zoladex but I think I've

conquered that now and am back to the "fighting weight" of my fifties. Every time I see a hospital or GP data collection sheet attempting to calculate my BMI and assign some meaning to this, I object and tell them to look at a better measure - for example, body fat %. Big is NOT obese. Rant over. Until they deal with PSA and body fat % I don't think the stats will mean a thing. Terry, I sign off as another elite athlete.... Terry Herbert wrote: Obesity? Hmm ….this Reuters report seems to refer to the study posted below where PSA numbers in Japan were compared with PSA numbers in the USA – anyone spot any potential anomalies in that kind of comparison? But that isn’t the main issue that sprang to mind when I read this – after all there are US studies of US men, one of which has this conclusion <snip> Across the study population, increased BMI [body Mass Index] was significantly inversely associated with lower PSA. Based on a theoretical model in which increased plasma volume in the obese dilutes PSA levels we propose new cut-points for a positive screening test. <snip> The theoretical model referred to <snip> ….. accurately predicted observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml in morbidly obese men. <snip> A curious feature of this study was that changes in the BMI of the men in the study were not associated with changes in PSA levels. Huh? So once you’re obese/overweight, your PSA remains at a lower level than normal even when you cease to be obese/overweight? How Can that be? But to get back to my meandering thoughts. I was very surprised to find last year that I fell into the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s more, to get to the median level of ‘normal’ weight I would have to lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very depressing, until I happened to go to the footy (Australian Rules Football) and read up on some of the player’s vital

statistics. Many of them are obese too, by the BMI calculation, yet some run the equivalent of a marathon during the course of a game. Checking on other codes – rugby union/rugby league - I found the same thing. These elite athletes were obese, just like me. Well, not just like me to be fair, they were fit and muscular and I wasn’t. I have lost a good deal of weight – I was concerned about possible weight gain following commencement of ADT (Androgen Deprivation Therapy) – and I am still overweight, but not so concerned about that. But back to the study conclusions mentioned above (and in the Reuters report <snip> Obese men have lower PSA

values likely due to excess blood volume," Freedland, the senior investigator on the study, told Reuters Health. <snip>) that it is the increased plasma/blood volume that lowers the PSA, then surely tall, large non-obese men would have lower than PSA numbers than less tall, smaller non-obese men? After all they probably have a greater blood/plasma volume? My doesn’t it get complicated? And is there really anything to be learned from these studies? Do they really help newly diagnosed men; or men who are choosing treatment or men who have had treatment or…..do they just waste bandwidth? All the best Terry Herbert I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then. My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data" Urology. 2008 May 30. [Epub ahead of print] Inverse Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006. Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y, Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S. Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of

Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan. OBJECTIVES: To confirm an inverse relationship between obesity and serum prostate-specific antigen (PSA) levels in Japanese men with a smaller body mass index (BMI) than white and African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men aged >20 years who visited our medical center for a health checkup from January 2004 to December 2006. The men were divided into 6 groups by age decade, and the BMI was categorized into 5 groups. The body fat percentage (BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2) test was used to check for trends in proportions of subjects with abnormal PSA values for each cutoff point (2.5 and 4.0 ng/mL) in

these groups. The relationships between the PSA levels and BMI or BFP were examined using multivariate analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2 kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with an abnormal PSA value increased significantly with age (P for trend < .0001); however, no trends were found across the BMI or BFP categories. The geometric mean PSA level increased significantly with age (P for linear trend < .0001) and decreased with BMI and BFP categories (P for linear trend = .001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings have demonstrated an inverse relationship between obesity and PSA levels even in Japanese men with a low prevalence of obesity, such as was previously reported for American men. Therefore, in prostate cancer screening, obesity, which can affect the accuracy of PSA testing, independent of race and ethnicity, should be taken into

account. PMID: 18514773 [PubMed - as supplied by publisher] From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of

Kathy MeadeSent: Saturday, 28 June 2008 11:55 PMTo: ProstateCancerSupport ; ProstateCancerCommunityLeaders ; NASPCC ; VAPCACOALITION Subject: Obesity may interfere with prostate cancer screening http://in.reuters.com/article/health/idINSIB80429320080628Obesity may interfere with prostate cancer screenReuters India - Mumbai,India"The current data," the researchers conclude, "suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity." Thank you Jack

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[Guest guest]

This BMI obsession on the part of medicos rooted in the past needs killing off. BMI is NOT an measure of obesity. You need to look at chest, waist and hip measurements. Is the guy apple shaped? - that's bad. Is he inverted pear shaped? - that's probably OK. Much better to look at body fat %, whatever the shape. I say with feeling as a bloke built like a rugby forward (which I was as a scholboy) but not fat (when I was checked 10-12 years ago, I was off the scale in terms of very low fat) but in BMI terms I was over 30 on the index. Yet I was playing cricket twice a week in the summer and (field) hockey once or twice also in the winter. I was never fitter than in my fifties. I used to joke about being "heavy boned", but it isn't that. Like Terry, I am still classed as obese in BMI tables but it obviously isn't so when you see me. I put on weight on first going on Zoladex but I think I've

conquered that now and am back to the "fighting weight" of my fifties. Every time I see a hospital or GP data collection sheet attempting to calculate my BMI and assign some meaning to this, I object and tell them to look at a better measure - for example, body fat %. Big is NOT obese. Rant over. Until they deal with PSA and body fat % I don't think the stats will mean a thing. Terry, I sign off as another elite athlete.... Terry Herbert wrote: Obesity? Hmm ….this Reuters report seems to refer to the study posted below where PSA numbers in Japan were compared with PSA numbers in the USA – anyone spot any potential anomalies in that kind of comparison? But that isn’t the main issue that sprang to mind when I read this – after all there are US studies of US men, one of which has this conclusion <snip> Across the study population, increased BMI [body Mass Index] was significantly inversely associated with lower PSA. Based on a theoretical model in which increased plasma volume in the obese dilutes PSA levels we propose new cut-points for a positive screening test. <snip> The theoretical model referred to <snip> ….. accurately predicted observed PSA levels and suggests that a screening PSA of 4.0 ng/ml in normal weight and overweight men corresponds to 3.5 ng/ml in obese men and 3.1 ng/ml in morbidly obese men. <snip> A curious feature of this study was that changes in the BMI of the men in the study were not associated with changes in PSA levels. Huh? So once you’re obese/overweight, your PSA remains at a lower level than normal even when you cease to be obese/overweight? How Can that be? But to get back to my meandering thoughts. I was very surprised to find last year that I fell into the definition of obesity according to the BMI calculator( see http://nhlbisupport.com/bmi/bmicalc.htm if you want to calculate your own BMI) and what’s more, to get to the median level of ‘normal’ weight I would have to lose well over 25 kilograms (55 lbs) and land up looking positively skeletal. Very depressing, until I happened to go to the footy (Australian Rules Football) and read up on some of the player’s vital

statistics. Many of them are obese too, by the BMI calculation, yet some run the equivalent of a marathon during the course of a game. Checking on other codes – rugby union/rugby league - I found the same thing. These elite athletes were obese, just like me. Well, not just like me to be fair, they were fit and muscular and I wasn’t. I have lost a good deal of weight – I was concerned about possible weight gain following commencement of ADT (Androgen Deprivation Therapy) – and I am still overweight, but not so concerned about that. But back to the study conclusions mentioned above (and in the Reuters report <snip> Obese men have lower PSA

values likely due to excess blood volume," Freedland, the senior investigator on the study, told Reuters Health. <snip>) that it is the increased plasma/blood volume that lowers the PSA, then surely tall, large non-obese men would have lower than PSA numbers than less tall, smaller non-obese men? After all they probably have a greater blood/plasma volume? My doesn’t it get complicated? And is there really anything to be learned from these studies? Do they really help newly diagnosed men; or men who are choosing treatment or men who have had treatment or…..do they just waste bandwidth? All the best Terry Herbert I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then. My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za Dr “Snuffy” Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data" Urology. 2008 May 30. [Epub ahead of print] Inverse Relationship Between Obesity and Serum Prostate-Specific Antigen Level in Healthy Japanese Men: A Hospital-Based Cross-Sectional Survey, 2004-2006. Ando R, Nagaya T, Hashimoto Y, Suzuki S, Itoh Y, Umemoto Y, Ikeda N, Tozawa K, Kohri K, Tokudome S. Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of

Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Urology, Chunichi Hospital, Nagoya, Japan. OBJECTIVES: To confirm an inverse relationship between obesity and serum prostate-specific antigen (PSA) levels in Japanese men with a smaller body mass index (BMI) than white and African-American men. METHODS: We analyzed 5246 apparently healthy Japanese men aged >20 years who visited our medical center for a health checkup from January 2004 to December 2006. The men were divided into 6 groups by age decade, and the BMI was categorized into 5 groups. The body fat percentage (BFP) was also used and was grouped into quartiles. The Mantel-Haenszel chi(2) test was used to check for trends in proportions of subjects with abnormal PSA values for each cutoff point (2.5 and 4.0 ng/mL) in

these groups. The relationships between the PSA levels and BMI or BFP were examined using multivariate analysis. RESULTS: The median age, BMI, BFP, and PSA level was 46 years, 23.2 kg/m(2), 21.5%, and 0.78 ng/mL, respectively. The proportion of subjects with an abnormal PSA value increased significantly with age (P for trend < .0001); however, no trends were found across the BMI or BFP categories. The geometric mean PSA level increased significantly with age (P for linear trend < .0001) and decreased with BMI and BFP categories (P for linear trend = .001 and P for linear trend = .002, respectively). CONCLUSIONS: Our findings have demonstrated an inverse relationship between obesity and PSA levels even in Japanese men with a low prevalence of obesity, such as was previously reported for American men. Therefore, in prostate cancer screening, obesity, which can affect the accuracy of PSA testing, independent of race and ethnicity, should be taken into

account. PMID: 18514773 [PubMed - as supplied by publisher] From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of

Kathy MeadeSent: Saturday, 28 June 2008 11:55 PMTo: ProstateCancerSupport ; ProstateCancerCommunityLeaders ; NASPCC ; VAPCACOALITION Subject: Obesity may interfere with prostate cancer screening http://in.reuters.com/article/health/idINSIB80429320080628Obesity may interfere with prostate cancer screenReuters India - Mumbai,India"The current data," the researchers conclude, "suggest that the PSA cut-points used to recommend biopsy need to be adjusted for the degree of obesity." Thank you Jack

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