Table 2.
Characteristics of identified studies on body-mass index and biochemical recurrence after prostate cancer treatment (N=16)
| Source | Study characteristics | BMI measurement | Definition of recurrence | No. of subjects | No. of recurrence (%) | BMI categories and RR (95% CI) | RR per 5 kg/m2 increase of BMI (95% CI) and P-value | Confounders adjusted | |
|---|---|---|---|---|---|---|---|---|---|
| Primary Treatment: Radical prostatectomy (N=11) | |||||||||
|
Bassett(42) (Urology, 2005) |
Period: 1989–2002 Setting: 31 cites, USA Treatment: RP Median follow-up: 1.9 yrs |
Not indicated | First PSA≥0.2ng/mL or if a second treatment after RP was needed | 2,131 | 251 (12%) | Continuous | 1.20 (1.02–1.41) | 2.46 (1.10–5.48) P=0.03 |
Stage, PSA, biopsy Gleason score, age, ethnicity, comorbidities (hyptertension, diabetes, heart disease) |
|
Strom(43) (Clin Cancer Res, 2005) |
Period: 1991–2001 Setting: 1 center, USA Treatment: RP Average follow-up: 4.5 yrs |
Self reported at diagnosis | PSA≥0.1ng/mL | 526 | 97 (18%) | Continuous <30 ≥30 <30 ≥30 <30 ≥30 |
At diagnosis 1.07 (1.02–1.13) 1.00 1.41(0.91–2.18) At age 25(univariate) 1.00 2.31 (1.01–5.30) At age 40 (univariate) 1.00 2.35 (1.43–3.86) |
1.40 (1.10–1.84) P=0.01 |
Preoperative PSA, Gleason score, pathologic stage, extraprostatic extension, seminal vesicle invasions, surgical margins, lymph node metastasis |
|
Freedland(36) (Clin Cancer Res, 2005) |
Period: 1985–2004 Setting: 1 surgeon at 1 center, USA Treatment: RP Median follow-up: 5 yrs |
Preoperative, retrieved from medical records | PSA≥0.2ng/mL | 2,832 | 374 (14%) | <30 ≥30 |
1.00 1.36 (0.98–1.89) |
1.36 (0.98–1.89) P=0.07 |
Age, race, height, year of surgery, clinical stage, biopsy Gleason sum, preoperative PSA; prostate weight, pathologic Gleason sum, positive surgical margins, extraprostatic extension, seminal vesicle invasion and lymph node metastasis |
|
Siddiqui(12) (Cancer, 2006) |
Period:1990–1999 Setting: 1 center, USA Treatment: RP Median follow-up: 10.1 yrs |
Measured at surgery | PSA≥0.4 ng/mL | 5,313 | 1,687 (32%) | Continuous | 1.00 (0.99–1.01) | 1.00 (0.95–1.05) P=0.86 |
Gleason Score, preoperative serum PSA, surgical margin status, seminal vesicle invasion, adjuvant treatment. |
|
Spangler(37) (J Urol, 2007) |
Period: 1995–2004 Setting: 1 center, USA Treatment: RP Median follow-up: 3 yrs |
Self reported at baseline | PSA≥0.2ng/dL | 924 140 784 |
153 (17%) 29 (21%) 124 (16%) |
<30 ≥30 <30 ≥30 <30 ≥30 |
Overall 1.00 1.76 (1.26–2.47) African American 1.00 5.49 (2.16–13.9) European American 1.00 1.41 (0.96–2.08) |
1.76 (1.26–2.47) | Age, race, stage, pathology Gleason grade and seminal vesicle invasion |
|
Hisasue(15) (Jpn J Clin Oncology, 2008) |
Period: 1998–2006 Setting: 1 center, Japan Treatment: RP Median follow-up: 1.4 yrs |
Pre-operative data | PSA elevation≥0.2 ng/mL | 126 | 30 (23%) | <26.4 ≥26.4 |
1.00 3.53 (1.29–9.68) |
3.53 (1.29–9.68) P=0.01 |
Age, surgical period, total testerone, PSA, T1c, Gleason sum, surgical margin |
|
Freedland(33) (BJU Int, 2008) |
Period: 1988–2006 Setting: 1 center (DPC), USA Treatment: RP Mean follow-up: 4.5 yrs |
Not indicated | Single PSA >0.2ng/mL, two of 0.2ng/mL, or secondary treatment for a high PSA level after RP | 2,014 | 483 (24%) | <25 25–29.9 30–34.9 ≥35 |
1.00 1.16 (0.92–1.46) 1.43 (1.08–1.88) 1.29 (0.87–1.92) |
1.14 (1.05–1.25) P<0.01 |
Age, race, biopsy Gleason sum, clinical stage, preoperative PSA, year at surgery |
|
Magheli(26) (Urology, 2008) |
Period: 1984–2006 Setting: 1 center, USA Treatment: RP Mean follow-up: 4.5 yrs |
Not indicated | PSA≥0.2 ng/mL | 5,631 | Not indicated | <25 25–30 ≥30 |
1.00 1.15 (0.89–1.49) 1.53 (1.20–1.96) |
1.22 (1.09–1.36) P<0.001 |
Age, race, Gleason score, preoperative PSA, clinical stage, year of surgery |
|
van Roermund(48) (BJU Int, 2009) |
Period: 1992–2005& 1998–2007 Setting: 2 centers, Netherlands Treatment: RP Median follow-up: 4.9 yrs |
Preoperative, from anaesthesia records | Two subsequent PSA>0.1 ng/mL or if a second treatment after RP was needed | 1,302 | 297 (22.8%) | <25 25–30 ≥30 |
1.00 0.98 (0.74–1.29) 0.72 (0.40–1.30) |
0.92 (0.75–1.12) P=0.4 |
Not clearly indicated, Gleason score, pathological stage |
|
King(47) (Int J Radiat Oncol Biol Phys, 2009) |
Period: 1984–2004 Setting: USA Treatment: RP+salvage RT Median follow-up: 3.7 yrs |
Clinical information, retrieved at the time of salvage RT | PSA≥0.2ng/mL with repeated measures | 90 | 40 (36%) | Continuous | 1.2 (1.04–1.4) | 2.49 (1.22–5.38) P=0.01 |
Preoperative PSA, Gleason, seminal vesicle, extracapsular extension, surgical margin, dose, pre-RT PSA, whole pelvic RT |
|
Jayachandran (16) (Cancer, 2009) |
Period: Not indicated Setting: multi-centers, USA Treatment: RP Median follow-up: 3.3 yrs |
At surgery | Single PSA>0.2ng/mL, or 2 PSA at 0.2ng/mL, or if a second treatment after RP was needed | Total 1,415 Black 662 White 753 |
Total 452 (31.9%) Black 222 (33.5%) White 230 (30.5%) |
Continuous | Black 1.04 (1.01–1.07) White 1.06 (1.03–1.10) |
Black 1.22 (1.05–1.40) P=0.01 White 1.34 (1.16–1.61) P<0.001 |
Age, pathological Gleason score, prostate weight, extracapsular extension, positive surgical margins, seminal vesicale invasion, lymph node involvement, preoperative PSA, year of surgery and center |
| Source | Study characteristics | BMI measurement | Definition of recurrence | No. of subjects | No. of recurrence (%) | BMI categories and RR (95% CI) | RR per 5 kg/m2 increase of BMI (95% CI) and P-value | Confounders adjusted | Source |
|---|---|---|---|---|---|---|---|---|---|
| Primary Treatment: Radiation therapy (N=5) | |||||||||
|
Strom(44) (Cancer, 2006) |
Period: 1988–2001 Setting: 1 center, USA Treatment: EBRT Average follow-up: 8 yrs |
Retrieved from chart at initial examination of EBRT | ASTRO, 3 consecutive increases in post-treatment PSA after achievement of a nadir | 873 | 168 (19%) | Continuous | 1.04 (1.02–1.07) | 1.22 (1.10–1.40) P<0.01 |
Clinical stage, Gleason score, PSA, dose, year of diagnosis |
|
Efstathiou(14) (Cancer, 2007) |
Period:1995–2001 Setting: multi-center trial, USA Treatment: RT+ADT Median follow-up: 6.9 yrs |
Available at baseline | PSA≥1.0 ng/mL and increased by more than 0.2ng/mL on 2 consecutive measurements | 99 | 25 (25%) | Continuous | 1.10 (1.01–1.19) | 1.61 (1.05–2.39) P=0.03 |
PSA, age, Gleason, stage |
|
Stroup(45) (Cancer, 2007) |
Period: 1989–2003 Setting: multi-center database, USA Treatment: EBRT Median follow-up: 3.6 yrs |
Retrieved from medical record | PSA nadir+ ≥2ng/mL | 1,320 | 554 (42%) | Continuous | 1.03 (1.01–1.05) P<0.01 |
1.13 (1.03–1.25) P<0.01 |
PSA, dose, ethnicity, stage, Gleason score, Neoadjuvant ADT, PSA nadir after EBRT, year of diagnosis |
|
Efstathiou(46) (Int J Radiat Oncol Biol Phys, 2008) |
Period: 1996–2001 Setting: 2 centers, USA Treatment: Brachytherapy Median follow-up: 6 yrs |
Available at baseline | PSA nadir+ ≥2ng/mL | 353 | 76 (21%) | <25 25–30 ≥30 |
1.00 0.76 (0.45–1.29) 0.56 (0.29–1.10) |
0.75 (0.43–1.32) P=0.32 |
Age, race, preimplantation PSA, Gleason score, T stage, percent of prescription dose to 90% of the prostate, use of supplemental EBRT and ADT |
|
van Roermund(13) (BJU Int, 2009) |
Period: 1991–2008 Setting: 1center, Netherlands Treatment: Brachytherapy Median follow-up: 3.9 yrs |
Preoperative, from anaesthesia records | PSA nadir+ ≥2ng/mL | 1,530 | 249 (16.3%) | <25 25–30 ≥30 |
1.00 1.00 (0.77–1.31) 1.15 (0.72–1.85) |
1.04 (0.87–1.24) P=0.7 |
Age, risk group(stage, grade and preoperative PSA), preoperative PLND, treatment period, number of seeds |
Abbreviations: BMI, body-mass index; RR, relative risk; CI: confidence interval; PCa: prostate cancer; RP, prostatectomy, RT, radiation therapy; ADT, androgen deprivation therapy; EBRT, external beam radiation therapy