The association of diabetes and obesity with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study.
OBJECTIVE
Few studies have investigated the role of race in the association of diabetes and obesity with prostate cancer aggressiveness. Here we evaluate the independent association between diabetes and obesity with prostate cancer aggressiveness in White Americans and Black Americans.


METHODS
Our cross-sectional, case-only study consisted of 1,058 White Americans and 991 Black Americans from the North Carolina-Louisiana Prostate Cancer (PCaP) project. Diabetes status was determined by self-report. Obesity was determined using body mass index and calculated based on anthropometric measurements. High aggressive prostate cancer was defined as Gleason sum ≥8, or prostate-specific antigen >20 ng/ml, or Gleason sum = 7 and clinical stage cT3-cT4. The association between diabetes and obesity with high aggressive prostate cancer at diagnosis was evaluated using multivariable logistic regression and adjusted for potential confounders.


RESULTS
Diabetes was not associated with high aggressive prostate cancer in the overall sample (OR 1.04; 95% CI 0.79, 1.37), White Americans (OR 1.00; 95% CI 0.65, 1.57) or Black Americans (OR 1.07; 95% CI 0.75, 1.53). Obesity, independent of diabetes, was positively associated with high aggressive prostate cancer in White Americans (OR 1.98; 95% CI 1.14, 3.43), but not in the overall sample (OR 1.37; 95% CI 0.99, 1.92) or Black Americans (OR 1.09; 95% CI 0.71, 1.67).


CONCLUSIONS
Diabetes was not associated with prostate cancer aggressiveness, overall, or in either race group. Obesity, independent of diabetes, was associated with high aggressive prostate cancer only in White Americans.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA. khans@wudosis.wustl.edu.|Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave., St. Louis, MO, 63110, USA. khans@wudosis.wustl.edu.
Saira
http://orcid.org/0000-0002-9024-9461
S
Khan
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
Jianwen
J
Cai
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.|Department of Urology, School of Medicine, University of North Carolina-Chapel Hill, 170 Manning Dr., Chapel Hill, NC, 27599, USA.|Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
Matthew E
ME
Nielsen
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.|Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
Melissa A
MA
Troester
Department of Urology, School of Medicine, University of North Carolina-Chapel Hill, 170 Manning Dr., Chapel Hill, NC, 27599, USA.|Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.|Department of Urology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.|Department of Urology, University of Buffalo School of Medicine and Biotechnology, 100 High Street, Buffalo, NY, 14203, USA.
James L
JL
Mohler
School of Public Health, Louisiana State University Health Science Center, 2020 Gravier Street, New Orleans, LA, 70112, USA.
Elizabeth T H
ET
Fontham
Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
Laura H
LH
Hendrix
Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
Laura
L
Farnan
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.|Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
Andrew F
AF
Olshan
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.|Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
Jeannette T
JT
Bensen
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000208:ethnology*; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology* / Q000208:ethnology*; D017430:Prostate-Specific Antigen / Q000378:metabolism; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000208:ethnology* / Q000378:metabolism; D057566:Self Report; D044465:White People / Q000706:statistics & numerical data*
D017430:Prostate-Specific Antigen
Aggressiveness; Black Americans; Diabetes; Obesity; PCaP; Prostrate cancer