Evidence suggests that visceral fat quantity may be associated with post-prostatectomy outcomes and risk of prostate cancer-related death. We aimed to evaluate if increased fat volume, normalized to prostate size, is associated with decreased risk of disease progression.
Patients enrolled on a prospective active surveillance trial for at least 6 months who had an MRI within 2 years of enrollment were eligible. The surveillance protocol included a standardized follow-up regimen consisting of biennial PSA and exam and yearly biopsy. Clinicopathologic characteristics were collected at baseline. Three fat measurements were taken using prostate MRI images: subcutaneous, linear periprostatic (pubic symphysis to prostate) and volumetrically-defined periprostatic. Progression was defined as increase in Gleason grade group. Multivariable cox proportional hazards models were used to evaluate fat volumes normalized by prostate size (stratified into tertiles).
A total of 175 patients were included. Average age was 62.5 years (SD 7.4) and average PSA was 5.4 ng/dL (STD 3.9). Median follow-up was 42 months (IQR 18-60) and 50/175 patients (28.6%) progressed. Compared to the lowest tertile, the highest tertile of volumetric peri-prostatic fat measurement (HR 2.63, 95 CI 1.23-5.60, P=0.01) and linear peri-prostatic fat measurement (HR 2.30, 95 CI 1.01-5.22, P=0.05) were associated with worsened progression free survival, while subcutaneous fat measurement (P=0.97) was not. Importantly, the model did not substantively change when accounting for patient body mass index and other factors.
Increased peri-prostatic fat volume, normalized to prostate size, may be associated with shortened progression-free survival in men with prostate cancer managed on active surveillance.
The Journal of urology. 2020 Jul 27 [Epub ahead of print]
Justin R Gregg, Devaki Shilpa Surasi, Alexandria Childs, Nicholas Moll, John F Ward, Jeri Kim, Carrie R Daniel, Christopher Logothetis, Tharakeswara Bathala, John W Davis
University of Texas MD Anderson Cancer Center, Houston, Texas., Merck & Co., Inc., Kenilworth, New Jersey.