Abstract
We recently found a negative association between body mass index (BMI) and the risk of localised prostate cancer (PCa), no association with advanced PCa, and a positive association with PCa‐specific mortality. In a 15% subpopulation of that study, we here investigated the measures of abdominal adiposity including waist circumference (WC) and A Body Shape Index (ABSI) in relation to PCa risk and mortality. We used data from 58,457 men from four Swedish cohorts to assess WC and ABSI in relation to PCa risk according to cancer risk category, including localised asymptomatic and symptomatic PCa and advanced PCa, and PCa‐specific mortality. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During, on average, 10 years of follow‐up, 3290 men were diagnosed with PCa and 387 died of PCa. WC was negatively associated with the risk of total PCa (HR per 10 cm, 0.95; 95% CI 0.92–0.99), localised PCa (HR per 10 cm, 0.93, 95% CI 0.88–0.96) and localised asymptomatic PCa cases detected through a prostate‐specific antigen (PSA) test (HR per 10 cm, 0.87, 95% CI 0.81–0.94). WC was not associated with the risk of advanced PCa (HR per 10 cm, 1.02, 95% CI 0.93–1.14) or with PCa‐specific mortality (HR per 10 cm, 1.04, 95% CI 0.92–1.19). ABSI showed no associations with the risk of PCa or PCa‐specific mortality. While the negative association between WC and the risk of localised PCa was partially driven by PSA‐detected PCa cases, no association was found between abdominal adiposity and clinically manifest PCa in our population.
Highlights
Obesity is a rapidly growing public health concern and accurate measures of body fatness are needed to clarify its role in the incidence and prognosis of prostate cancer (PCa).[1]
We found that the negative association between body mass index (BMI) and the risk of localised PCa was partially driven by PCa cases detected through asymptomatic testing,[5] which supports a role for detection bias in the obesity–P Ca association
We found a negative association between BMI and the risk of localised PCa (HR per 5 kg/m2, 0.90; 95% confidence interval (CI) 0.85–0 .97) and no association with advanced PCa (HR per 5 kg/m2, 1.04; 95% confidence intervals (95% CIs) 0.90–1 .21) (Table 3), which are in agreement with our previous study of BMI and PCa risk with a much larger study sample (HRs per 5 kg/m2, 0.93; 95% CI 0.91–0 .96, and 1.01; 95% CI 0.97–1 .06, respectively)
Summary
Obesity is a rapidly growing public health concern and accurate measures of body fatness are needed to clarify its role in the incidence and prognosis of prostate cancer (PCa).[1]. Studies investigating WC and PCa risk found mostly null or negative associations with localised PCa risk but null or positive associations with advanced PCa risk.3,4,6,9-12 A body shape index (ABSI), a measure based on WC, weight and height and independent from BMI, showed no association with the risk of PCa.[10] The various findings for anthropometric measures across PCa risk categories, and the different prognosis of PCa even within specific subgroups,[13] highlight the diversity of PCa and the need for further investigation by use of detailed clinical characteristics of the PCa. The differential associations of PCa by disease severity have been hypothesised to be attributed to clinical characteristics of men with obesity that may influence the detection of PCa, such as a lower serum prostate-specific antigen (PSA) concentration,14-16 and a larger prostate gland compared to normal weight men, which may lower the detection through biopsy.[17] more active screening behaviour in normal weight men compared to men with obesity may be involved. We investigated the associations between abdominal adiposity measures including WC and ABSI and PCa risk, by cancer risk category and the reason for PCa detection (asymptomatic or symptomatic), and PCa-specific mortality, in a subset of men of our previous study of body size and PCa
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