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Ben Hadj Alouane H, Raboudi M, Maatougui J, Dridi M, Ghozzi S. Are Diabetic Patients at Increased Risk for Biochemical Recurrence After Radical Prostatectomy? Cureus 2022; 14:e24717. [PMID: 35663714 PMCID: PMC9164171 DOI: 10.7759/cureus.24717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Diabetic patients are at a lower risk for prostate cancer. However, the relationship between diabetes mellitus (DM) and biochemical recurrence (BCR) after radical prostatectomy (RP) is less clear. The goal of our study was to determine diabetes's value as a biochemical recurrence predictor. Materials and methods We conducted a retrospective analysis of 117 patients who had undergone open radical prostatectomy between 1999 and 2021 at our institution. Univariate and multivariate statistical analyses were used to identify factors associated with biochemical recurrence. Results On univariate analysis, factors associated with biochemical recurrence were diabetes (p=0.002), preoperative prostate-specific antigen (PSA) levels (p=0.022), positive digital rectal exam (p=0.035), number of positive biopsy cores (p<0.001), unfavorable intermediate risk group (p=0.014), peri-neural invasion (PNI) on RP specimen (p=0.043), tumor volume (p=0.011), and positive surgical margins (p<0.001). Multivariate analysis showed that factors independently associated with biochemical recurrence were diabetes (p=0.039; OR=2.788), number of positive cores (p=0.016; OR=4.124), and positive surgical margins (p=0.008; OR=3.876). Conclusion A history of diabetes mellitus should be taken into consideration when assessing patients' risk of biochemical recurrence after radical prostatectomy. More research on a larger scale is needed to determine diabetes' value as a biochemical predictor.
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Affiliation(s)
| | - Mehdi Raboudi
- Department of Urology, Military Hospital of Tunis, Tunisia, TUN
| | | | - Mohamed Dridi
- Department of Urology, Military Hospital of Tunis, Tunisia, TUN
| | - Samir Ghozzi
- Department of Urology, Military Hospital of Tunis, Tunisia, TUN
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Rivera-Izquierdo M, Pérez de Rojas J, Martínez-Ruiz V, Arrabal-Polo MÁ, Pérez-Gómez B, Jiménez-Moleón JJ. Obesity and biochemical recurrence in clinically localised prostate cancer: a systematic review and meta-analysis of 86,490 patients. Prostate Cancer Prostatic Dis 2022; 25:411-421. [PMID: 34987170 DOI: 10.1038/s41391-021-00481-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The association of obesity with biochemical recurrence (BCR) after treatment of clinically localised prostate cancer (PC) shows inconsistent results. Our aim was to systematically review all evidence evaluating obesity as a prognostic factor for BCR. METHODS We searched PubMed, Web of Science and Scopus, from inception to June 1, 2021. Cohort studies reporting BCR among PC patients stratified by body mass index (BMI) were included. To assess the quality of the selected studies, we used the Newcastle-Ottawa scale (NOS). Risk of BCR among obese patients (BMI ≥ 30 kg/m2) was compared with normal weight (BMI < 25), pooling individual hazard ratios (HR) in random-effect meta-analysis. Associations for continuous BMI per 5 kg/m2 were also calculated. Subgroup analyses were conducted to assess reasons for heterogeneity and causal criteria were formally evaluated. RESULTS We identified 46 cohort studies including 86,490 PC patients. A total of 14,719 (17.1%) patients developed BCR. There was no consistent definition of BCR. Obesity was associated with BCR (HR: 1.25, 95% CI: 1.11-1.39, I2: 70.3%), and there was a 10% increase (95% CI: 4-15%, I2: 66.3%) in BCR per 5 kg/m2 increase in BMI. The heterogeneity was high but decreased in the subgroup of highest-quality NOS score and when the BMI was measured by the researchers (I2: 0.0%). The association was consistent in patients receiving radical prostatectomy but not in patients receiving other therapies. CONCLUSIONS Obesity showed a moderate, consistent relationship with biochemical recurrence after radical prostatectomy. Measurement of BMI and BCR was variable, highlighting the need for standardised clinical guidelines. Preventive weight control programs may have a role in reducing BCR for clinically localised PC patients.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain. .,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain. .,Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, Granada, Spain.
| | - Javier Pérez de Rojas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Beatriz Pérez-Gómez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Epidemiology of Chronic Diseases. National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - José Juan Jiménez-Moleón
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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3
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Luo R, Chen Y, Ran K, Jiang Q. Effect of obesity on the prognosis and recurrence of prostate cancer after radical prostatectomy: a meta-analysis. Transl Androl Urol 2020; 9:2713-2722. [PMID: 33457243 PMCID: PMC7807337 DOI: 10.21037/tau-20-1352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Obesity has been found to be closely related to the increased risk of fatal prostate cancer (PCa), however there remains no evidence that further clarifies the relationship between obesity and the postoperative recurrence and poor prognosis of PCa. In this study, a systematic review and meta-analysis were performed to systematically evaluate the effect of obesity on the prognosis and recurrence of PCa after radical prostatectomy (RP). Methods A literature search of the PubMed, Web of Science, and Embase databases was performed covering articles published between January 2013 and January 2020. Articles regarding the correlation between body mass index (BMI) and the prognosis and recurrence of PCa following RP were included in the meta-analysis. Two investigators independently screened the literature and extracted relevant data including publication information, key results, number of cancer cases, and multivariable-adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.3 and Stata 16.0 software, and forest plots, funnel plots, and sensitivity analysis were also conducted. Results A total of 14 articles were included, all of which were analyzed for clinicopathological characteristics. Eight articles reported the biochemical recurrence (BCR) with prostate-specific antigen (PSA) as the predictor, and six articles reported the positive surgical margins (PSM). The meta-analysis showed that obese PCa patients had more postoperative recurrence and poor prognosis compared with the normal weight PCa patients, and the difference was statistically significant (OR =1.25, 95% CI: 1.10, 1.43). BCR exhibited no significant difference between obese and non-obese PCa patients after surgery (OR =1.2, 95% CI: 0.96, 1.46), and there were also no notable differences in PSM between the groups (OR =1.16, 95% CI: 0.99, 1.36). Subgroup analysis showed that obese PCa patients in the Americas (95% CI: 1.11, 1.37) and Europe (95% CI: 1.11, 1.78) were more likely to have surgical recurrence and poor prognosis (OR =1.40). Obese patients in the Americas were also more likely to have BCR after surgery (95% CI: 1.07, 1.36). Conclusions Obesity easily leads to poor prognosis and recurrence of PCa after RP.
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Affiliation(s)
- Runtian Luo
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongbo Chen
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Ran
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Foerster B, Pozo C, Abufaraj M, Mari A, Kimura S, D'Andrea D, John H, Shariat SF. Association of Smoking Status With Recurrence, Metastasis, and Mortality Among Patients With Localized Prostate Cancer Undergoing Prostatectomy or Radiotherapy: A Systematic Review and Meta-analysis. JAMA Oncol 2019; 4:953-961. [PMID: 29800115 DOI: 10.1001/jamaoncol.2018.1071] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Studies investigating the association of cigarette smoking with prostate cancer incidence and outcomes have revealed controversial results. Objective To systematically review and analyze the association of smoking status with biochemical recurrence, metastasis, and cancer-specific mortality among patients with localized prostate cancer undergoing primary radical prostatectomy or radiotherapy. Data Sources A systematic search of original articles published between January 2000 and March 2017 was performed using PubMed, MEDLINE, Embase, and Cochrane Library databases in March 2017. Study Selection Observational studies reporting Cox proportional hazards regression or logistic regression analyses were independently screened. Data Extraction and Synthesis This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. Available multivariable hazard ratios (HRs) and corresponding 95% CIs were included in quantitative analysis. A risk-of-bias assessment was completed for nonrandomized studies. Main Outcomes and Measures Prespecified outcomes of interest were biochemical recurrence, metastasis, and cancer-specific mortality. Results A total of 5157 reports were identified, of which 16 articles were selected for qualitative analysis and 11 articles were selected for quantitative analysis. All included studies were observational and nonrandomized and comprised a total of 22 549 patients. Overall, 4202 patients (18.6%) were current smokers. The overall median follow-up was 72 months. Current smokers had a statistically significantly higher risk of biochemical recurrence (HR, 1.40; 95% CI, 1.18-1.66; P < .001 [10 studies]), as did former smokers (HR, 1.19; 95% CI, 1.09-1.30; P < .001 [7 studies]). Current smokers were also at a higher risk of metastasis (HR, 2.51; 95% CI, 1.80-3.51; P < .001 [3 studies]) and cancer-specific mortality (HR, 1.89; 95% CI, 1.37-2.60; P < .001 [5 studies]), whereas former smokers were not (metastasis: HR, 1.61; 95% CI, 0.65-3.97; P = .31 [2 studies]; cancer-specific mortality: HR, 1.05; 95% CI, 0.81-1.37; P = .70 [4 studies]). Conclusions and Relevance Current smokers at the time of primary curative treatment for localized prostate cancer are at higher risk of experiencing biochemical recurrence, metastasis, and cancer-specific mortality.
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Affiliation(s)
- Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Carmen Pozo
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Andrea Mari
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Shoji Kimura
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, New York.,Department of Urology, University of Texas Southwestern Medical Center, Dallas.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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Salji M, Hendry J, Patel A, Ahmad I, Nixon C, Leung HY. Peri-prostatic Fat Volume Measurement as a Predictive Tool for Castration Resistance in Advanced Prostate Cancer. Eur Urol Focus 2018; 4:858-866. [PMID: 28753854 PMCID: PMC6314965 DOI: 10.1016/j.euf.2017.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 01/17/2017] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity and aggressive prostate cancer (PC) may be linked, but how local peri-prostatic fat relates to tumour response following androgen deprivation therapy (ADT) is unknown. OBJECTIVE To test if peri-prostatic fat volume (PPFV) predicts tumour response to ADT. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective study on consecutive patients receiving primary ADT. From staging pelvic magnetic resonance imaging scans, the PPFV was quantified with OsirixX 6.5 imaging software. Statistical (univariate and multivariate) analysis were performed using R Version 3.2.1. RESULTS AND LIMITATIONS Of 224 consecutive patients, 61 with advanced (≥T3 or N1 or M1) disease had (3-mm high resolution axial sections) pelvic magnetic resonance imaging scan before ADT. Median age=75 yr; median PPFV=24.8cm3 (range, 7.4-139.4cm3). PPFV was significantly higher in patients who developed castration resistant prostate cancer (CRPC; n=31), with a median of 37.9cm3 compared with 16.1cm3 (p <0.0001, Wilcoxon rank sum test) in patients who showed sustained response to ADT (n=30). Multivariate analysis using Cox proportional hazards models were performed controlling for known predictors of CRPC. PPFV was shown to be independent of all included factors, and the most significant predictor of time to CRPC. Using our multivariate model consisting of all known factors prior to ADT, PPFV significantly improved the area under the curve of the multivariate models receiver operating characteristic analysis. The main study limitation is a relatively small cohort to account for multiple variables, necessitating a future large-scale prospective analysis of PPFV in advanced PC. CONCLUSIONS PPFV quantification in patients with advanced PC predicts tumour response to ADT. PATIENT SUMMARY The amount of fat around the prostate predicts prostate cancer response to hormone treatment.
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Affiliation(s)
- Mark Salji
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK; CRUK Beatson Institute, Glasgow, Scotland, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Jane Hendry
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Amit Patel
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Imran Ahmad
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK; CRUK Beatson Institute, Glasgow, Scotland, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Colin Nixon
- CRUK Beatson Institute, Glasgow, Scotland, UK
| | - Hing Y Leung
- Department of Urology, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK; CRUK Beatson Institute, Glasgow, Scotland, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK.
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HITOSUGI M, MUKAISHO K, KIDO M, KAMIMURA S, FURUKAWA S, SUGIHARA H. No change in the prevalence of latent prostate cancer over the last 10 years: a forensic autopsy study in Japan . Biomed Res 2017; 38:307-312. [DOI: 10.2220/biomedres.38.307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Masahito KIDO
- Department of Urology, Jikei University School of Medicine
| | | | - Satoshi FURUKAWA
- Department of Legal Medicine, Shiga University of Medical Science
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7
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Time Trends in Histological Features of Latent Prostate Cancer in Japan. J Urol 2016; 195:1415-1420. [DOI: 10.1016/j.juro.2015.11.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2015] [Indexed: 11/24/2022]
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8
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Bai PD, Hu MB, Xu H, Zhu WH, Hu JM, Yang T, Jiang HW, Ding Q. Body mass index is associated with higher Gleason score and biochemical recurrence risk following radical prostatectomy in Chinese men: a retrospective cohort study and meta-analysis. World J Surg Oncol 2015; 13:311. [PMID: 26542246 PMCID: PMC4635546 DOI: 10.1186/s12957-015-0725-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 10/28/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The aim of the study is to investigate whether body mass index (BMI) affected pathological characteristics and biochemical recurrence (BCR) of prostate cancer after radical prostatectomy in Chinese men. METHODS Medical records of 211 Chinese patients who underwent radical prostatectomy between 2006 and 2014 were retrospectively reviewed, with follow-up time of 24.5 ± 27.0 months. Multivariate logistic and Cox regression analyses were applied to address the impact of BMI on adverse pathological outcomes and BCR following prostatectomy. A meta-analysis of published studies from MEDLINE or EMBASE was conducted to determine the relationship between BMI and BCR following prostatectomy among Asian populations. RESULTS Higher BMI was positively correlated with higher biopsy Gleason score (odds ratios (OR) 1.163, 95 % confidence interval (CI) 1.023-1.322, P = 0.021) and pathological Gleason score (OR 1.220, 95 % CI 1.056-1.410, P = 0.007) in multivariate analysis. BCR was detected in 48 patients (22.7 %). Multivariate Cox proportional hazards analysis revealed that higher BMI (hazard ratio (HR) 1.145, 95 % CI 1.029-1.273, P = 0.013) and prostate-specific antigen (HR 1.659, 95 % CI 1.102-2.497, P = 0.015) levels were independent predictors of BCR. The meta-analysis enrolled eight Asian studies of 4145 patients treated by radical prostatectomy. Based on random-effects approach, a 5 kg/m(2) increase in BMI was correlated with 28 % higher risk of BCR (HR 1.22, 95 % CI 0.86-1.72) without statistical significance. CONCLUSIONS The present study suggested that higher BMI was an independent risk factor for a higher Gleason score, as well as an independent predictor of BCR after radical prostatectomy in Chinese patients. Meta-analysis of Asian studies also indicated that obese patients, although without statistical significance, might be more likely to suffer from BCR.
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Affiliation(s)
- Pei-De Bai
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Meng-Bo Hu
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Hua Xu
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Wen-Hui Zhu
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Ji-Meng Hu
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Tian Yang
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Hao-Wen Jiang
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, No.12 Middle Wulumuqi Road, Shanghai, 200040, China.
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