PURPOSE: Higher BMI is linked to lower PSA.
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This has given rise to concerns PSA may be less reliable for predicting prostate cancer among obese men. We test the accuracy of pre-biopsy PSA for predicting prostate cancer across BMI categories.
MATERIAL AND METHODS: We used the REDUCE study, which tested dutasteride for prostate cancer risk reduction in men with a PSA of 2.5-10.0 ng/mL and a negative pre-study biopsy. All men were required to have a biopsy at 2- and 4-years independent of PSA. We assessed the performance of pre-biopsy PSA to predict overall and high-grade prostate cancer (Gleason sum ≥7) within each BMI group using the area under the ROC curve (AUC).
RESULTS: Of 6,103 men who had a 2-year biopsy, 1,646 (27%) were normal weight, 3,209 (53%) overweight, and 1,248 (20%) were obese. Mean-adjusted PSA values for normal weight, overweight, and obese subjects on placebo were 7.73, 7.17, and 6.79 ng/mL (p-trend=0.192), and on dutasteride were 3.16, 2.93, and 2.62 ng/mL (p=0.008). AUC analysis using raw PSA data for predicting prostate cancer ranged from 0.60-0.64 in the placebo arm and from 0.58-0.66 in the dutasteride arm with no difference across BMI categories (p-interactions≥0.212). Similar results were found for high-grade prostate cancer with AUCs ranging from 0.69-0.70 in the placebo arm and 0.65-0.75 in the dutasteride arm but no differences across BMI categories (p-interactions≥0.157).
CONCLUSIONS: Among men with a previous negative biopsy, the accuracy of pre-biopsy PSA to predict overall and high-grade prostate cancer was independent of BMI.
Vidal AC, Howard LE, Moreira DM, Castro-Santamaria R, Andriole GL, Freedland SJ. Are you the author?
Duke Prostate Center, Division of Urological Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; Surgery Section, Durham VA Medical Center, Durham, NC, USA; Mayo Clinic, Department of Urology, Rochester, MN, USA; GlaxoSmithKline Inc., Metabolic Pathways and Cardiovascular R&D Unit, King of Prussia, PA, USA; Washington University School of Medicine in St. Louis, St. Louis, Missouri; Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
Reference: J Urol. 2015 Feb 5. pii: S0022-5347(15)00236-0.