title: Influence of obesity on the incidence and treatment of genitourinary malignancies.
abstract: BACKGROUND
  Obesity is a growing epidemic in the United States. Many genitourinary malignancies are ranked among the current leading causes of cancer. As a result, there has been a surge of interest in understanding the impact of obesity on genitourinary malignancies. We sought to review the current literature concerning the influence of obesity on prostate, kidney, and bladder cancer.
  
  
  METHODS
  A PubMed search was performed using key words related to incidence, treatment, obesity, prostate, kidney, and bladder cancer. Relevant articles and their references were reviewed and utilized.
  
  
  RESULTS
  Obesity appears to promote an increased risk of aggressive prostate cancer (CaP). This may be related, in part, to a detection bias found in obese men. Worse surgical and radiation treatment outcomes in the obese appear to be related not only to technical challenges, but also inherent tumor biology differences and more aggressive disease presentations. A strong association between obesity and increased risk of renal cell carcinoma (RCC) has been established. Laparoscopic radical nephrectomy is now felt to be feasible in the obese and may be a lower morbidity technique compared with open surgery. Interestingly, obesity may confer an improved tumor-specific survival for localized RCC post nephrectomy. The influence of body mass index (BMI) on bladder cancer is poorly understood. Although a relationship may exist, due to the mixed and minimal observations, no firm conclusions should be drawn. Greater perioperative risks following open cystectomy have been found to occur in obese patients secondary to increase technical challenges.
  
  
  CONCLUSIONS
  The relationship between obesity and genitourinary malignancy is impressive. Technical challenges undoubtedly play a role in influencing treatment outcomes. Inherent biological effects are also likely influential. Future research is necessary to delineate these mechanisms and further clarify the influence of obesity on genitourinary cancer.
authors.affiliation: Division of Urologic Surgery and Duke Prostate Center, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. suzanne.stewart@duke.edu
authors.forename: Suzanne Biehn
authors.initials: SB
authors.lastname: Stewart
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000150:complications*; D014565:Urogenital Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*