Endocrine Abstracts

Introduction: Prostate cancer is the second most frequent malignancy in men, with more than 1.4 million new cases diagnosed in 2020¹. Obesity, on the other hand, has reached epidemic proportions, with 59% of adults living with overweight or obesity in Europe². Our aim was asses the impact of weight and BMI on prostate cancer (PCa) severity, reflected in PSA levels.

Methods: We analyzed 225 patients diagnosed with PCa between August 2001 and May 2022 through transrectal prostate biopsy and referred to the Oncology Department of Neolife Medical Center in Bucharest, Romania. Weight, BMI and PSA levels were noted at diagnosis. Lining up with the NCCN risk stratification³, we divided the patients into two PSA groups: <20 ng/ml and ≥20 ng/ml.

Results: Obesity was seen in 71 (31.6%) patients. Median PSA level (IQR) was 12.8 (29.4) ng/ml. 143 (63.6%) patients had PSA <20 ng/ml, while 82 (36.4%) ≥20 mg/ml. Binary logistic regression analysis was performed to asses the effects of weight on the risk of having PSA levels >20 ng/ml. An increase in weight was associated with a decreased likelihood of having PSA >20 ng/ml (OR = 0.974, 95% CI: 0.954 – 0.994, P=0.011). Similarly, binary logistic regression analysis was performed to asses the effects of BMI on the risk of having PSA levels >20 ng/ml. An increase in BMI was associated with a decreased likelihood of having PSA >20 ng/ml (OR = 0.925, 95% CI: 0.864 – 0.989, P=0.023). There was a good capacity of weight (AUROC = 0.604, 95% CI: 0.527 – 0.682, P=0.009; cut-off = 81.5 kg, Se = 57.3%, SP=60.8%) and BMI (AUROC = 0.583, 95% CI: 0.505 – 0.661, P=0.038; cut-off = 24.7 kg/m², Se = 32.9%, SP=81.1%) to predict the presence of PSA levels >20 ng/ml.

Discussions: It is known that the hemodilution and lower testosterone levels in patients with obesity are associated with lower PSA levels. Ultimately, obesity could delay PCa diagnosis through lower PSA levels.

References: 1. H. Sung et al., ‘Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.,’ CA. Cancer J. Clin., vol. 71, no. 3, pp. 209–249, May 2021, doi: 10.3322/caac.21660. 2. ‘Obesity and overweight.’ https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed Jun. 12, 2022). 3. D. Freedman-Cass et al., ‘NCCN Guidelines Version 4.2023 Prostate Cancer,’ Accessed: Jan. 19, 2024. [Online]. Available: https://www.nccn.org/home/.