Association of Obesity With Prostate Specific Antigen and Prostate Specific Antigen Velocity in Healthy Young Men

Systematic review and meta-analysis of the associations between body mass index, prostate cancer, advanced prostate cancer, and prostate-specific antigen

PURPOSE

The relationship between body mass index (BMI) and prostate cancer remains unclear. However, there is an inverse association between BMI and prostate-specific antigen (PSA), used for prostate cancer screening. We conducted this review to estimate the associations between BMI and (1) prostate cancer, (2) advanced prostate cancer, and (3) PSA.

METHODS

We searched PubMed and Embase for studies until 02 October 2017 and obtained individual participant data from four studies. In total, 78 studies were identified for the association between BMI and prostate cancer, 21 for BMI and advanced prostate cancer, and 35 for BMI and PSA. We performed random-effects meta-analysis of linear associations of log-PSA and prostate cancer with BMI and, to examine potential non-linearity, of associations between categories of BMI and each outcome.

RESULTS

In the meta-analyses with continuous BMI, a 5 kg/m2 increase in BMI was associated with a percentage change in PSA of - 5.88% (95% CI - 6.87 to - 4.87). Using BMI categories, compared to normal weight men the PSA levels of overweight men were 3.43% lower (95% CI - 5.57 to - 1.23), and obese men were 12.9% lower (95% CI - 15.2 to - 10.7). Prostate cancer and advanced prostate cancer analyses showed little or no evidence associations.

CONCLUSION

There is little or no evidence of an association between BMI and risk of prostate cancer or advanced prostate cancer, and strong evidence of an inverse and non-linear association between BMI and PSA. The association between BMI and prostate cancer is likely biased if missed diagnoses are not considered.

Relationship between insulin resistance, obesity and serum prostate-specific antigen levels in healthy men

The purpose of this study was to determine the relationship between insulin resistance, obesity and serum prostate-specific antigen (PSA) levels in healthy men with serum PSA level below 4 ng mL(-1). The men included in the study cohort were 11 827 healthy male employees of the Korea Hydro and Nuclear Power Co., LTD who had undergone medical checkups including fasting glucose, fasting insulin and serum PSA between January 2003 and December 2008. Insulin resistance was calculated by homeostasis model assessment (HOMA [fasting glucose x fasting insulin]/22.5) and quantitative insulin sensitivity check index (QUICKI; 1/[log (fasting insulin) + log (fasting glucose)]). Age-adjusted body mass index (BMI) was significantly increased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI, respectively, in analysis of variance (ANOVA) test and Duncan's multiple comparison test (P < 0.001), but age-adjusted serum PSA concentration was significantly decreased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI (P < 0.001). Age, BMI, insulin resistance by HOMA or QUICKI were significantly independent variables to serum PSA level in a multivariate linear regression analysis (P < 0.001). Insulin resistance was a significant independent variable to serum PSA level along with BMI. Insulin resistance and BMI were negatively correlated with serum PSA level in healthy men. Insulin resistance was positively correlated with BMI.

The clinical significance in healthy men of the association between obesity related plasma hemodilution and tumor marker concentration

PURPOSE

We investigated the association between body mass index and the concentration of tumor markers including carcinoembryonic antigen, alpha-fetoprotein, the carbohydrate antigen 19-9 and prostate specific antigen, as well as the association between body mass index changes and tumor marker concentration changes in a population of healthy men.

MATERIALS AND METHODS

We evaluated data on 8,776 men screened for tumor markers (carcinoembryonic antigen, alpha-fetoprotein, carbohydrate antigen 19-9 and prostate specific antigen) at least 3 times annually during an annual examination from 2001 to 2007. We assessed the tumor marker test findings for a trend in the age, alanine aminotransferase and creatinine adjusted tumor marker concentration by body mass index. We used multivariate regression analysis to determine whether a change in body mass index was associated with a tumor marker concentration change over time using calculated tumor markers, body mass index, creatinine and alanine aminotransferase concentration change per year.

RESULTS

After adjusting for age, creatinine and alanine aminotransferase a higher body mass index was associated with lower prostate specific antigen (p for trend <0.001), carcinoembryonic antigen (p for trend <0.001) and carbohydrate antigen 19-9 (p for trend <0.001). On multivariate regression analysis each 1 kg/m(2) of body mass index gain per year was associated with a -0.011 ng/ml change in prostate specific antigen concentration, a -0.030 ng/ml change in carcinoembryonic antigen concentration and a -0.192 IU/ml change in carbohydrate antigen 19-9 concentration per year.

CONCLUSIONS

In this cohort of healthy men hemodilution from increased plasma volume may be responsible for the observed decreased tumor marker concentration in men with a higher body mass index. In addition, an increase in body mass index may predict a lower tumor marker concentration in an individual.

Effect of ageing and body mass index on prostate-specific antigen levels among Chinese men in Singapore from a community-based study

OBJECTIVE To assess the effect of ageing and body mass index (BMI) on prostate-specific antigen (PSA) among Chinese men from the results of the 2005 Prostate Awareness Week in Singapore. SUBJECTS AND METHODS In all, 2714 men participated in the programme, consisting of 2431 Chinese, 114 Malays, 117 Indians and 52 'others'. Of these, 2410 Chinese men who had a PSA level of <20 ng/mL and were aged >50 years but <80 years were included in the analysis. Height and weight were used to calculate the BMI. The relationship between age and PSA levels was analysed using linear regression and bivariate correlation, and the associations among different groups of BMI and PSA levels were analysed using analysis of variance and covariance. RESULTS PSA levels were significantly correlated with age (correlation coefficient, r = 0.27, P < 0.001). Analyses showed a significant inverse association between PSA level and BMI; mean PSA levels decreased with increasing BMI for both standards (standard classification; geometric mean, GM, PSA of 1.08, 1.06, 0.96, 0.83 ng/mL for a BMI of <18.5, 18.5-24.9, 25-29.9 and > or =30 kg/m(2), respectively, P trend <0.01; and for Asian classification, GM PSA 1.08, 1.09, 0.96, 0.91 ng/mL for a BMI of <18.5, 18.5-22.9, 23-27.5 and > or =27.5, respectively, P trend <0.001). There were significant differences (P < 0.05) in the age-adjusted GM PSA levels for the groups with BMI <25 (1.05 ng/mL) and BMI > or =25 kg/m(2) (0.97 ng/mL). Similarly, there were significant differences (P < 0.05) in the age-adjusted GM PSA levels in those with a BMI of <30 (1.03 ng/mL) and > or =30 kg/m(2) (0.85 ng/mL). CONCLUSION These data suggest that the BMI in Chinese men in Singapore is significantly associated with PSA levels, especially among the obese men aged 70-79 years.

Relationship between serum prostate-specific antigen levels and components of metabolic syndrome in healthy men

OBJECTIVES

To assess the correlation between age, body mass index, systolic and diastolic blood pressure (BP), triglycerides, high-density lipoprotein (HDL), and fasting blood glucose (FBG) and the serum prostate-specific antigen (PSA) level and to determine the significant factors for predicting the serum PSA level in men with a low risk of prostate cancer.

METHODS

A total of 38 356 healthy male employees of the Korea Electric Power Corporation who were <60 years old and had a serum PSA level of <4 ng/mL were enrolled in this study from January 2002 to December 2006. Their BP, body weight, and body height were measured, and biochemical analyses of FBG, triglycerides, HDL, and serum PSA were performed.

RESULTS

The mean age +/- standard deviation was 44.38 +/- 7.90 years; the mean serum PSA level was 0.89 +/- 0.51 ng/mL; and the incidence of metabolic syndrome was 25.8%. On univariate analysis, significant correlations were noted between the serum PSA level and body mass index, diastolic BP, HDL, and FBG (P < .05). Multiple logistic regression analyses using 4 percentiles (10th, 25th, 75th, and 90th percentile) of the serum PSA level revealed trends for a positive association between older age and diastolic BP and the serum PSA level. The body mass index, HDL, and FBG correlated negatively with the serum PSA level.

CONCLUSIONS

These results suggest that the serum PSA level is significantly influenced by age and some components of the metabolic syndrome (obesity, diastolic BP, HDL, and FBG).

Association between serum prostate-specific antigen level, liver function tests and lipid profile in healthy men

OBJECTIVE

To assess the association between serum prostate-specific antigen (PSA) level and age, liver function tests (LFTs) including alkaline phosphatase (ALP), total bilirubin (TB), lipid profile (total cholesterol, TC, triglycerides, TG, high-density lipoprotein, HDL) and fasting blood sugar (FBS), and to determine the significant factors for predicting the serum PSA level in men with a low risk of having prostate cancer.

SUBJECTS AND METHODS

In all, 38 157 healthy male employees of the Korea Electric Power Corporation (KEPCO) who were aged <60 years and had serum PSA levels of <4 ng/mL and serum creatinine levels of <1.4 mg/dL were enrolled between January 2002 and December 2006. Body weight and height were measured, and levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), ALP, TB, FBS, TC, TG, and HDL, and serum PSA were measured.

RESULTS

The mean (sd) age of the study population was 44.4 (7.90) years and the mean PSA level 0.89 (0.51) ng/mL. In a univariate analysis there were significant interrelations between serum PSA level and age, BMI, AST, ALT, ALP, TB, HDL and FBS (P < 0.05). The multiple logistic regression analyses using four percentiles (10th, 25th, 75th, 90th percentile) of serum PSA level showed trends that being older was associated with serum PSA level, and that BMI, ALT, HDL and FBS were negatively correlated with serum PSA level.

CONCLUSIONS

These results suggest that serum PSA level was significantly influenced by age, BMI, ALT, HDL and FBS. Further studies are needed to confirm our results and to explain the underlying mechanisms.