Relationship between obesity and prostate cancer

Purpose of review: This review examines the relationship between obesity and prostate cancer, with an update of recent research in this field. Recent findings: A recent report of the Cancer Prevention Study II showed a direct relationship between increasing body mass index and prostate cancer mortality. However, the US Health Professionals Followup Study reported an inverse association between obesity and the risk of developing prostate cancer in men under 60 years of age or in those with a family history of prostate cancer. These studies illustrate the contradictory evidence linking obesity to prostate cancer risk and mortality. Body mass does not appear to affect the performance of prostate-specific antigen as a diagnostic test, and on prostate biopsy a lower body mass is associated with a higher cancer detection rate and a higher cancer volume as measured by core length involvement. In two recent radical prostatectomy series, obesity was associated with worse pathological features and higher biochemical recurrence rates. The higher risk of recurrence persisted in patients with organ-confined disease and negative surgical margins, implying that this risk is not related to surgical technique. Several potential biological mechanisms have been proposed to explain this link including hormonal alterations, hyperinsulinemia, glucose intolerance, and elevated insulin-like growth factor and leptin levels. Summary: Recent literature provides evidence that obesity may promote the development of a more aggressive form of prostate cancer, resulting in higher recurrence rates after primary therapy and higher cancer mortality rates overall. The mechanism to explain the association between obesity and prostate cancer is unclear.