title: Correlation of High Body Mass Index With More Advanced Localized Prostate Cancer at Radical Prostatectomy Is Not Reflected in PSA Level and PSA Density but Is Seen in PSA Mass.
abstract: OBJECTIVE
  Prostate cancer screening algorithms and preoperative nomograms do not include patients' body mass index (BMI). We evaluated outcomes at radical prostatectomy (RP) adjusted to BMI.
  
  
  METHODS
  Serum prostate-specific antigen (PSA) levels, PSA mass, PSA density (PSAD), and RP findings were analyzed with respect to BMI in 4,926 men who underwent RP between 2005 and 2014.
  
  
  RESULTS
  In total, 1,001 (20.3%) men were normal weight, 2,547 (51.7%) were overweight, and 1,378 (28%) were obese. Median PSA levels (ng/mL) were normal weight, 5.0; overweight, 5.1; and obese, 5.2 (P = .094). Median PSA mass increased with increasing BMI: 15.9 vs 17.4 vs 19.4 μg (P < .001). Median PSAD was not significantly different: 0.11 vs 0.11 vs 0.11 ng/mL/g (P = .084). Median prostate weight increased with increasing BMI: 44 vs 45 vs 49 g (P < .001). Median prostatectomy tumor volume increased with increasing BMI: 3.9 vs 4.7 vs 5.9 cm(3) (P < .001). Overweight and obese patients had a higher Gleason score and more locally advanced cancer (P < .001). Frequency of positive surgical margins increased with higher BMIs (P < .001). Frequency of lymph node metastasis did not differ significantly (P = .088).
  
  
  CONCLUSIONS
  While BMI correlates with tumor volume, Gleason score, and extent of disease at RP, there is no routinely measured clinical parameter reflecting this. Only PSA mass highlights this correlation. Thus, BMI and potentially PSA mass should be taken into account in predictive algorithms pertaining to prostate cancer and its surgical treatment.
authors.affiliation: From the Departments of Pathology and Urology, University of Miami Miller School of Medicine, Miami, FL; Department of Pathology and o.kryvenko@med.miami.edu.
authors.forename: Oleksandr N
authors.initials: ON
authors.lastname: Kryvenko
authors.affiliation: Departments of Pathology, Urology, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD; and.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Epstein
authors.affiliation: Department of Pathology and.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Meier
authors.affiliation: Department of Pathology and.
authors.forename: Nilesh S
authors.initials: NS
authors.lastname: Gupta
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI.
authors.forename: Mireya
authors.initials: M
authors.lastname: Diaz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D009765:Obesity / Q000097:blood / Q000150:complications*; D050177:Overweight / Q000097:blood / Q000150:complications; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery
chemical_list: D017430:Prostate-Specific Antigen
keywords: BMI; PSA; PSA mass; Prostate cancer; Prostatectomy