Platinum Priority – Review – Prostate CancerEditorial by Lars Holmberg on pp. 821–822 of this issueObesity and Prostate Cancer: Weighing the Evidence☆
Introduction
Prostate cancer (PCa) is the second most commonly diagnosed cancer and the sixth most common cause of cancer-related mortality among men worldwide [1]. In the last decade, multiple epidemiologic studies have suggested that obesity is associated with increased risk and death from numerous cancer types including PCa [2], [3], [4]. Like PCa, obesity affects many men, with two-thirds of the US classified as overweight (body mass index [BMI] ≥25 kg/m2) and one-third as obese (BMI ≥30 kg/m2). These trends have stabilized in the past 10 yr [5], suggesting these levels are established as a permanent feature of US society. In Europe, the prevalence of overweight and obesity continues to rise, and current levels are comparable with those of the United States 15 yr ago [6].
Because obesity and PCa affect substantial proportions of the male population, the association between the two is of great public health significance. Existing epidemiologic data are somewhat conflicting, and the consolidation and review of findings to date is required. Attention is increasingly turning to the elucidation of underlying molecular mechanisms, a number of which are emerging. This review focuses on the epidemiologic association between obesity and PCa incidence, treatment, and mortality, in addition to proposed underlying molecular mechanisms. It concludes with clinical recommendations for our obese patients. The contribution of specific dietary components, clearly intertwined with obesity, is the focus of our companion review [7]. We previously reviewed the literature on this topic several years ago [8]. At that time, a PubMed search of obesity and PCa generated 237 articles. The same search in July 2012 generated 796 articles, a greater than three-fold increase in the past 5 yr (Fig. 1). Thus we decided an updated review was needed.
Section snippets
Evidence acquisition
Relevant literature published between January 1991 and July 2012 was identified by a search of the PubMed database using the following terms: obesity, BMI, body mass index combined with prostate cancer risk, prostate cancer incidence, prostate cancer mortality, radical prostatectomy, androgen-deprivation therapy, external-beam radiation, brachytherapy, quality of life, active surveillance, and prostate cancer combined with obesity, BMI, body mass index, and insulin, IGF, sex hormones,
Measuring obesity
BMI, calculated using an individual's height and weight (kilograms per square meter), is a straightforward and cost-effective method of measuring overall adiposity. Although BMI does not account for body mass composition or the distribution of adipose tissue, it has been repeatedly demonstrated as a reliable surrogate of obesity on a population level, with the advantage of being the most widely used measure, enabling interstudy comparisons. Thus, due to ease of use and near ubiquitous use in
Conclusions
The epidemiologic association of obesity and aggressive PCa is particularly relevant due to the pervasive nature of both diseases and the large numbers of men affected. Beyond age, race, and family history, there are few established risk factors for PCa. The identification of obesity as an additional risk factor for aggressive PCa is of significant public health interest due to its modifiable nature. Adipose tissue as an organ is unique in its capacity to expand and diminish throughout the
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