Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer.
BACKGROUND
Recent studies have suggested that obese men have lower serum prostate-specific antigen (PSA) concentrations than nonobese men. Because men with higher body mass index (BMI) have greater circulating plasma volumes, lower PSA concentrations among obese men may be due to hemodilution.


OBJECTIVE
To determine the association between hemodilution and PSA concentration in obese men with prostate cancer.


METHODS
Retrospective study of men who underwent radical prostatectomy for prostate adenocarcinoma from 1988 to 2006, using data from the databases of the Shared Equal Access Regional Cancer Hospital (n = 1373), Duke Prostate Center (n = 1974), and Johns Hopkins Hospital (n = 10 287). Multivariate linear regression models adjusting for clinicopathological characteristics were used to analyze the main outcome measures.


METHODS
Associations between BMI and mean adjusted PSA concentrations, mean plasma volume, and mean adjusted PSA mass (total circulating PSA protein, calculated as PSA concentration multiplied by plasma volume), assessed by determining P values for trend.


RESULTS
After controlling for clinicopathological characteristics, higher BMI was significantly associated with higher plasma volume (P < .001 for trend) and lower PSA concentrations (P < or = .02 for trend) in all cohorts. In 2 of the 3 cohorts, PSA mass did not change significantly with increasing BMI. In the third cohort, higher BMI was associated with increased PSA mass (P < .001 for trend), but only between BMI category less than 25 and the other categories.


CONCLUSIONS
In men undergoing radical prostatectomy, higher BMI was associated with higher plasma volume; hemodilution may therefore be responsible for the lower serum PSA concentrations among obese men with prostate cancer. Prospective studies are needed to evaluate this association in screened populations.
Bañez
Lionel L
LL
Division of Urologic Surgery and the Duke Prostate Center, and Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Hamilton
Robert J
RJ
Partin
Alan W
AW
Vollmer
Robin T
RT
Sun
Leon
L
Rodriguez
Carmen
C
Wang
Yiting
Y
Terris
Martha K
MK
Aronson
William J
WJ
Presti
Joseph C
JC
Kane
Christopher J
CJ
Amling
Christopher L
CL
Moul
Judd W
JW
Freedland
Stephen J
SJ
D000368:Aged; D015992:Body Mass Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D010953:Plasma Volume; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery
D017430:Prostate-Specific Antigen