title: Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy: biology or technique? Results from the SEARCH database.
abstract: BACKGROUND
  Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors.
  
  
  OBJECTIVE
  To examine whether obesity predicts higher prostate-specific antigen (PSA) nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men.
  
  
  METHODS
  A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration-based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo.
  
  
  METHODS
  All patients underwent RP.
  
  
  METHODS
  We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA nadir.
  
  
  CONCLUSIONS
  Mean BMI was 28.5 kg/m2. Higher BMI was associated with higher PSA nadir on both univariable (p=0.001) and multivariable analyses (p<0.001). Increased BMI was associated with increased BCR risk (hazard ratio [HR]: 1.06; p=0.007). Adjusting for PSA nadir slightly attenuated, but did not eliminate, this association (HR: 1.04, p=0.043). When stratified by PSA nadir, obesity only significantly predicted BCR in men with an undetectable nadir (p=0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available.
  
  
  CONCLUSIONS
  Obese men are more likely to have a higher PSA nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression.
authors.affiliation: Divison of Urologic Surgery, Department of Surgery, Duke Prostate Center, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Ho
authors.forename: Leah
authors.initials: L
authors.lastname: Gerber
authors.forename: William J
authors.initials: WJ
authors.lastname: Aronson
authors.forename: Martha K
authors.initials: MK
authors.lastname: Terris
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Presti
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Amling
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
mesh_terms: D000368:Aged; D015992:Body Mass Index; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen