• Stephen J Freedland, Leon Sun, Christopher J Kane, Joseph C Presti, Martha K Terris, Christopher L Amling, Judd W Moul, and William J Aronson.
• Urology Section, Department of Surgery, Veterans Affairs Medical Center, Duke University Medical Center, Durham, NC 27710, USA. steve.freedland@duke.edu
• BJU Int. 2008 Sep 1; 102 (8): 969-74.

ObjectiveTo indirectly test the hypothesis that prostate-specific antigen (PSA)-based screening is biased against obese men due to haemodilution of PSA, and thus results in delayed diagnosis and poorer outcome beyond the biological link between obesity and aggressive prostate cancer.Patients And MethodsWe sought to examine the association between body mass index (BMI) and the outcome of radical prostatectomy (RP) separately for men with PSA-detected cancers (cT1c) or with abnormal digital rectal examination (DRE) findings (cT2/T3), and stratified by year of treatment, using two large databases. We conducted a retrospective cohort study of 1375 and 2014 men treated by RP between 1988 and 2007 using the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases. We evaluated the association between BMI and adverse pathological features and biochemical progression, using logistic regression and Cox proportional hazards models, adjusting for several clinical characteristics, respectively. Data were examined as a whole and as stratified by clinical stage (cT1c vs cT2/T3) and year of surgery (>or=2000 vs <2000).ResultsIn both cohorts a higher BMI was associated with high-grade disease (P 0.3). Among men with T1c disease, the association between BMI and biochemical progression was limited to men treated in 2000 or later (P 0.4).ConclusionsObese men with PSA-detected cancers and treated with RP since 2000 were at significantly greater risk of biochemical progression, while obese men treated before 2000 or diagnosed with an abnormal DRE were not at significantly greater risk of progression. These findings support the hypothesis that current PSA-based screening is less effective at finding cancers in obese men, leading to more aggressive tumours at diagnosis. Lowering the PSA threshold for biopsy among obese men might help to improve outcomes among this high-risk group.

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