In the October issue of Cancer Epidemiology Biomarkers and Prevention, Gong and colleagues present data obtained from the PCPT which addresses this very issue.

Of 10,258 patients enrolled in the study who had a prostate biopsies performed, cancer was diagnosed in 1,936 patients (18.8%). The relationship between body-mass index and diabetes mellitus to prostate cancer aggressiveness was ascertained.

Compared to patients with a normal BMI < 25, obese patients (BMI ? 30) exhibited a 29% increased risk of high-grade prostate cancer (Gleason ? 7), with an odds ratio of 1.78 (95% CI, 1.0 to 1.67). The risk was highest for developing prostate cancers of Gleason score 8-10 (OR 1.78; 78% increased risk). Interestingly, obese patients were found to have an 18% decreased risk of low-risk prostate cancer (OR = 0.82, 95% CI 0.69 to 0.98). The presence of abdominal obesity only increase prostate cancer risk independent of BMI in men with a family history of prostate cancer. These differences were seen in both the placebo and finasteride arms.

Furthermore, the presence of diabetes mellitus independently decreased the risk of low-grade prostate cancer by 47% and of high grade disease by 28%. This statistical significance persisted on multivariate analysis after adjusting for BMI.

These unique data obtained from a prospective randomized trial suggest that obesity may preferentially increase the risk of high-grade prostate cancer, while decreasing the risk of developing low-grade tumors. The authors suggest that this may explain why no association between BMI and prostate cancer has been found in studies that have not subdivided patients based on Gleason score.

Zhihong Gong, Marian L. Neuhouser, Phyllis J. Goodman, Demetrius Albanes, Chen Chi, Ann W. Hsing, Scott M. Lippman, Elizabeth A. Platz, Michael N. Pollak, Ian M. Thompson, and Alan R. Kristal

Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1977-83

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Written by Ricardo Sånchez-Ortiz, MD, a Contributing Editor with UroToday.

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