644 OBESITY IS ASSOCIATED WITH CASTRATE RESISTANT DISEASE AND METASTASIS IN MEN TREATED WITH ANDROGEN DEPRIVATION THERAPY (ADT) FOR PSA-ONLY RECURRENCE AFTER RADICAL PROSTATECTOMY (RP): RESULTS FROM THE SEARCH DATABASE

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced1 Apr 2011644 OBESITY IS ASSOCIATED WITH CASTRATE RESISTANT DISEASE AND METASTASIS IN MEN TREATED WITH ANDROGEN DEPRIVATION THERAPY (ADT) FOR PSA-ONLY RECURRENCE AFTER RADICAL PROSTATECTOMY (RP): RESULTS FROM THE SEARCH DATABASE Christopher J. Keto, William J. Aronson, Martha K. Terris, Joseph C. Presti, Christopher L. Amling, Christopher J. Kane, and Stephen J. Freedland Christopher J. KetoChristopher J. Keto Durham, NC More articles by this author , William J. AronsonWilliam J. Aronson Los Angeles, CA More articles by this author , Martha K. TerrisMartha K. Terris Augusta, GA More articles by this author , Joseph C. PrestiJoseph C. Presti Palo Alto, CA More articles by this author , Christopher L. AmlingChristopher L. Amling Portland, OR More articles by this author , Christopher J. KaneChristopher J. Kane San Diego, CA More articles by this author , and Stephen J. FreedlandStephen J. Freedland Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1546AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A prior study found obese men on ADT had higher testosterone levels, which itself may be correlated with poorer outcome. Moreover, obesity is associated with prostate cancer (PC) death in otherwise “healthy men.” The association between obesity and progression after ADT is untested. We investigated the effect of obesity on PC specific outcomes in men treated with early ADT for PSA-only recurrence after RP. METHODS Retrospective review of 2892 men treated with RP between 1988 and 2010 in the SEARCH database. Body mass index (BMI) was calculated within one year of the start of ADT. BMI was analyzed as a categorical variable (<25, 25-30, and ≥30 Kg/m2). We also investigated whether obese men (BMI ≥30Kg/m2) had differences in PSA and PSA kinetics around the time of ADT (i.e. Pre-ADT PSA, Pre-ADT PSA doubling time [PSADT], and PSA nadir on ADT) using the rank sum test. Cox proportional hazards models were used to test the association between BMI and time to castration resistant PC (CRPC), metastases, and PC specific mortality (PCSM) adjusting for demographic and clinicopathological data along with pre-ADT PSA. RESULTS During a median 73 month follow-up after RP, 405 men (14%) received early ADT. Among 205 men with complete data, median BMI was 28.5 Kg/m2 (IQR: 25.3–32.7). Among these men, median follow-up from the start of ADT was 48 months during which 29 men developed CRPC, 20 metastases, and 12 died from PC. Obese men were more likely to progress to CRPC (HR=5.2, p=0.02) and metastases (HR=11.8, p=0.02). Though there was a trend for obese men to have increased PCSM (HR=9.0), few men died of PC and the association was not significant (p=0.12). Though there were trends for poorer outcomes, overweight was not significantly associated with CRPC (HR=3.4, p=0.09), metastases (HR=4.0, p=0.19), or PCSM (HR=4.5, p=0.27). Despite poorer progression, important prognostic variables did not differ between obese and non-obese men: Pre-ADT PSA (p=0.08), Pre-ADT PSADT (p=0.85), and PSA nadir during ADT (p=0.19). CONCLUSIONS Among men treated with early ADT, obese men had increased risk of CRPC, metastases, and PCSM. These data further support the hypothesis obesity is associated with aggressive PC. Alternatively, as suggested by a prior study, perhaps ADT in obese men provides inadequate androgen suppression. Further understanding of the mechanisms linking obesity and PCSM in men on ADT is warranted. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e260 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher J. Keto Durham, NC More articles by this author William J. Aronson Los Angeles, CA More articles by this author Martha K. Terris Augusta, GA More articles by this author Joseph C. Presti Palo Alto, CA More articles by this author Christopher L. Amling Portland, OR More articles by this author Christopher J. Kane San Diego, CA More articles by this author Stephen J. Freedland Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...