Obesity and Prostate Cancer

Marco Bandini; Giorgio Gandaglia; Alberto Briganti

Disclosures

Curr Opin Urol. 2017;27(5):415-421. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: To investigate the association between obesity and prostate cancer (PCa).

Recent findings: Obesity has been proposed to be involved in the pathogenesis of PCa through different biological mechanisms that include deregulation of the insulin axis, sex hormone secretion, adipokines signaling, and oxidative stress. Hypertrophic peritumoral adipocytes may also facilitate the local spread of PCa through the chemo-attraction of tumor cells. Clinical studies demonstrate that obesity might have clinical implications also in disease detection and management. Obese men have been shown to be less likely to be diagnosed with early-stage disease. Moreover, they are at increased risk of experiencing upgrading and upstaging when managed with active surveillance. However, the association between obesity and the risk of PCa recurrence and mortality after radical treatment is still debated.

Summary: Obesity may facilitate the development and progression of PCa trough different biologic mechanisms that may pose obese men at higher risk of advanced and high-grade disease. However, the association between obesity and long-term oncologic outcome after radical treatments appears unclear.

Introduction

The WHO defines overweight and obesity as abnormal or excessive fat accumulation that represents a risk to health.[1] These conditions are associated with an increased risk of a number of chronic diseases such as diabetes and cardiovascular diseases.[2,3] Moreover, several studies have shown that obesity is associated with an increased risk of numerous cancer types.[4–8] Of note, this condition might play a role also in the pathogenesis of prostate cancer (PCa). Several preclinical studies proposed multiple theories to explain the association between obesity and the pathogenesis of PCa,[9,10] with obese men being less likely to be diagnosed at earlier stages. Finally, obesity might influence functional and oncologic outcomes after radical treatments.[11,12]

Our review aims at critically analyzing the most recent evidences on the association between obesity and PCa. Specifically, we evaluated the role of obesity in the pathophysiology of PCa, its influence on the ability to detect PCa, and the potential effects of obesity on outcomes after radical treatments.

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