title: Abdominal obesity as risk factor for prostate cancer diagnosis and high grade disease: a prospective multicenter Italian cohort study.
abstract: OBJECTIVE
  To evaluate the association between abdominal obesity and prostate cancer (CaP) diagnosis and grade in patients undergoing prostate biopsy.
  
  
  METHODS
  Between 2008 and 2011, we prospectively enrolled patients referred to 3 clinics in Italy who were scheduled for transrectal ultrasound (TRUS) guided prostate biopsy. Before biopsy, digital rectal examination (DRE), prostate specific antigen (PSA), body mass index (BMI), and waist circumference (WC) were measured. Men were categorized in 4 groups of body habitus, according to BMI and waist circumference values. Crude and adjusted logistic regressions were performed to assess the association of BMI (continuous), waist circumference (continuous), body habitus (categorical), and CaP diagnosis and grade.
  
  
  RESULTS
  Six hundred sixty-eight patients were enrolled. CaP was detected in 246 patients (38%), of whom 136 had low-grade (Gleason score ≤ 6) and 110 high-grade cancer (Gleason score ≥ 7). Logistic regression multivariate analysis showed that BMI (OR 1.05 per unit, CI 95% 1.00-1.10 P = 0.033) and waist circumference (OR 1.02 per cm, CI 95% 1.00-1.04 P = 0.026) were significant predictors of CaP diagnosis. BMI (OR 1.11 95% CI 1.04-1.18 P = 0.001) and WC (OR 1.04 95% CI 1.02-1.06 P = 0.001) were also associated with high-grade CaP. Furthermore, obesity with central adiposity (BMI ≥ 30 kg/m(2) and WC ≥ 102 cm) was significantly associated with CaP diagnosis (OR 1.66, CI 95% 1.05-2.63, P = 0.03) and high-grade disease (OR 2.56, CI 95% 1.38-4.76, P = 0.003).
  
  
  CONCLUSIONS
  Obesity defined by BMI and WC seems to be associated with CaP and, more specifically, with high-grade disease at the time of biopsy. The relationship between obesity and CaP is complex and remains to be further addressed.
authors.affiliation: Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy. Electronic address: cosimodenunzio@virgilio.it.
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Simone
authors.initials: S
authors.lastname: Albisinni
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.forename: Lucio
authors.initials: L
authors.lastname: Miano
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Enrico
authors.initials: E
authors.lastname: Finazzi Agrò
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000368:Aged; D001706:Biopsy; D015992:Body Mass Index; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D056128:Obesity, Abdominal / Q000150:complications*; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000379:methods; D055105:Waist Circumference
chemical_list: D017430:Prostate-Specific Antigen