Tall height and obesity are associated with an increased risk of aggressive prostate cancer: results from the EPIC cohort study

The relationship between body size and prostate cancer risk, and in particular risk by tumour characteristics, is not clear because most studies have not differentiated between high-grade or advanced stage tumours, but rather have assessed risk with a combined category of aggressive disease. We investigated the association of height and adiposity with incidence of and death from prostate cancer in 141,896 men in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Multivariable-adjusted Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average of 13.9 years of follow-up, there were 7024 incident prostate cancers and 934 prostate cancer deaths.

Height was not associated with total prostate cancer risk. Subgroup analyses showed heterogeneity in the association with height by tumour grade (P heterogeneity = 0.002), with a positive association with risk for high-grade but not low-intermediate-grade disease (HR for high-grade disease tallest versus shortest fifth of height, 1.54; 95% CI, 1.18-2.03). Greater height was also associated with a higher risk for prostate cancer death (HR = 1.43, 1.14-1.80). Body mass index (BMI) was significantly inversely associated with total prostate cancer, but there was evidence of heterogeneity by tumour grade (P heterogeneity = 0.01; HR = 0.89, 0.79-0.99 for low-intermediate grade and HR = 1.32, 1.01-1.72 for high-grade prostate cancer) and stage (P heterogeneity = 0.01; HR = 0.86, 0.75-0.99 for localised stage and HR = 1.11, 0.92-1.33 for advanced stage). BMI was positively associated with prostate cancer death (HR = 1.35, 1.09-1.68). The results for waist circumference were generally similar to those for BMI, but the associations were slightly stronger for high-grade (HR = 1.43, 1.07-1.92) and fatal prostate cancer (HR = 1.55, 1.23-1.96).

The findings from this large prospective study show that men who are taller and who have greater adiposity have an elevated risk of high-grade prostate cancer and prostate cancer death.

BMC medicine. 2017 Jul 13*** epublish ***

Aurora Perez-Cornago, Paul N Appleby, Tobias Pischon, Konstantinos K Tsilidis, Anne Tjønneland, Anja Olsen, Kim Overvad, Rudolf Kaaks, Tilman Kühn, Heiner Boeing, Annika Steffen, Antonia Trichopoulou, Pagona Lagiou, Maria Kritikou, Vittorio Krogh, Domenico Palli, Carlotta Sacerdote, Rosario Tumino, H Bas Bueno-de-Mesquita, Antonio Agudo, Nerea Larrañaga, Elena Molina-Portillo, Aurelio Barricarte, Maria-Dolores Chirlaque, J Ramón Quirós, Pär Stattin, Christel Häggström, Nick Wareham, Kay-Tee Khaw, Julie A Schmidt, Marc Gunter, Heinz Freisling, Dagfinn Aune, Heather Ward, Elio Riboli, Timothy J Key, Ruth C Travis

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, United Kingdom. ., Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, United Kingdom., Molecular Epidemiology Group, Max Delbrueck Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany., Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece., Danish Cancer Society Research Center, Copenhagen, Denmark., Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark., Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany., Hellenic Health Foundation, Athens, Greece., Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy., Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention (CPO-Piemonte), Turin, Italy., Cancer Registry and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, Azienda Sanitaria Provinciale, Ragusa, Italy., Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom., Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain., Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain., CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain., Public Health Directorate, Asturias, Spain., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom., University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom., Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.