title: Measurement of peri-prostatic fat thickness using transrectal ultrasonography (TRUS): a new risk factor for prostate cancer.
abstract: Study Type - Prognosis (cohort) Level of Evidence 2b. What's known on the subject? and What does the study add? ADIPOSE tissue secretes various endocrine and paracrine mediators. Some authors have begun to consider whether peri-prostatic fat (PPF) may interact with the prostate and play a role in carcinogenesis. It has recently been shown that the PPF quantity measured by CT is associated with more aggressive disease in patients undergoing radiation therapy. Our group studied a population not yet diagnosed with prostate cancer. By doing so we were able to identify PPF thickness on transrectal ultrasonography as a risk factor for prostate cancer detection upon biopsy, and as a risk factor for high-grade disease. Our study also raises interesting questions about the underlying mechanisms of the association between PPF quantity and prostate cancer.
  
  
  OBJECTIVE
  To determine if the amount of peri-prostatic fat (PPF) on transrectal ultrasonography (TRUS) is a risk factor for incident prostate cancer overall and high-grade prostate cancer (Gleason ≥4).
  
  
  METHODS
  A prospectively maintained database of patients undergoing prostate biopsy at Princess Margaret Hospital for cancer suspicion was used. • All TRUS examinations were retrospectively reviewed upon 'blinding' to outcome. • PPF thickness, measured as the distance between the prostate and the pubic bone, was used as an index of the quantity of PPF. • PPF measurements, together with other prostate cancer risk factors, were evaluated against prostate cancer and high-grade prostate cancer detection upon biopsy with univariable and multivariable logistic regression and area under the receiver operating characteristic curve (AUC) analysis.
  
  
  RESULTS
  Of the 931 patients, 434 (47%) were diagnosed with prostate cancer and 218 (23%) were diagnosed with high-grade prostate cancer. • The mean (range) PPF thickness was 5.3 (0-15) mm. • Increasing PPF thickness was associated with prostate cancer and high-grade prostate cancer diagnosis, with graded effect. When adjusting for other variables, the odds of detecting any prostate cancer and high-grade prostate cancer increased 12% (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.02-1.23) and 20% (OR 1.20, 95% CI 1.07-1.34), respectively, for each millimetre increase in PPF thickness. • The AUCs for the association of PPF with prostate cancer and high-grade prostate cancer were 0.58 (95% CI 0.54-0.62) and 0.59 (95% CI 0.55-0.64), respectively.
  
  
  CONCLUSIONS
  The amount of PPF can be estimated with TRUS and is a predictor of prostate cancer and high-grade prostate cancer at biopsy. To our knowledge, this study is the first to investigate PPF quantity in patients without prior prostate cancer diagnosis.
authors.affiliation: Division of Urology, Department of Surgical Oncology, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada. bimal.bhindi@utoronto.ca
authors.forename: Bimal
authors.initials: B
authors.lastname: Bhindi
authors.forename: Greg
authors.initials: G
authors.lastname: Trottier
authors.forename: Malik
authors.initials: M
authors.lastname: Elharram
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Fernandes
authors.forename: Gina
authors.initials: G
authors.lastname: Lockwood
authors.forename: Ants
authors.initials: A
authors.lastname: Toi
authors.forename: Karen M
authors.initials: KM
authors.lastname: Hersey
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.forename: Andrew
authors.initials: A
authors.lastname: Evans
authors.forename: Theodorus H
authors.initials: TH
authors.lastname: van der Kwast
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology* / Q000648:ultrastructure; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography / Q000379:methods