Pruthi Raj S, Swords Kelly, Schultz Heather, Carson Culley C, Wallen Eric M
Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Urol. 2009 Feb;181(2):574-7; discussion 578. doi: 10.1016/j.juro.2008.10.028. Epub 2008 Dec 13.
The effect of obesity on prostate cancer detection and behavior remains uncertain. We evaluated the impact of obesity, as measured by body mass index, in a case series of 500 consecutive men who underwent a modern 10 to 12 core biopsy approach.
We retrospectively reviewed the records of a consecutive series of 500 men who underwent transrectal ultrasound guided prostate biopsy using a 10 to 12 core biopsy scheme. Variables, including patient age, prostate specific antigen, prostate specific antigen density, digital rectal examination findings, transrectal ultrasound prostate volume and biopsy outcome, including grade, were compared to anthropometric measures, including body mass index.
Of the men 26% were obese according to body mass index (greater than 30 kg/m(2)). A total of 223 men (45%) had a positive biopsy. Obese men were younger (62.0 vs 63.8 years), had a larger prostate (57.7 vs 47.8 cc) and were less likely to have any abnormality on digital rectal examination (19.6% vs 30.8%). Obese men were also less likely to have a positive biopsy based on chi-square analysis (38.8% vs 46.2%). On statistical modeling for the OR in nonobese vs obese men there was a trend toward lower detection based on crude and age adjusted ORs but not on multivariate OR controlling for age, prostate specific antigen and prostate volume. In addition, when examining for high grade disease (Gleason 4 + 3 or greater), no differences were observed on OR modeling. In men with negative biopsies those who were obese vs nonobese had a larger prostate volume and trended toward a higher median prostate specific antigen and age. These differences and trends were not observed in obese men with positive biopsies.
Of men undergoing prostate biopsy using a modern extended biopsy scheme obese men were younger, had a larger prostate and were less likely to have abnormal digital rectal examinations. Although some trends toward a lower detection rate in obese men were observed, such differences were not observed on multivariate analysis, nor were any differences observed in the incidence of higher grade tumors, thus questioning the effect of obesity on prostate cancer detection and behavior in our cases series.
肥胖对前列腺癌检测及病情的影响尚不确定。我们在一个包含500例连续接受现代10至12针活检方法的男性病例系列中，评估了以体重指数衡量的肥胖的影响。
我们回顾性分析了连续500例行经直肠超声引导下前列腺活检且采用10至12针活检方案的男性患者的记录。将包括患者年龄、前列腺特异性抗原、前列腺特异性抗原密度、直肠指检结果、经直肠超声测得的前列腺体积以及活检结果（包括分级）等变量，与包括体重指数在内的人体测量指标进行比较。
根据体重指数，26%的男性为肥胖（大于30kg/m²）。共有223名男性（45%）活检结果为阳性。肥胖男性更年轻（62.0岁对63.8岁），前列腺更大（57.7cc对47.8cc），直肠指检发现异常的可能性更小（19.6%对30.8%）。基于卡方分析，肥胖男性活检结果为阳性的可能性也更小（38.8%对46.2%）。在对非肥胖与肥胖男性的OR进行统计建模时，基于粗OR和年龄校正后的OR有检测率较低的趋势，但在控制年龄、前列腺特异性抗原和前列腺体积的多变量OR中未观察到该趋势。此外，在检查高级别疾病（Gleason 4 + 3或更高）时，OR建模未观察到差异。在活检结果为阴性的男性中，肥胖者与非肥胖者相比，前列腺体积更大，前列腺特异性抗原中位数和年龄有升高趋势。在活检结果为阳性的肥胖男性中未观察到这些差异和趋势。
在采用现代扩展活检方案进行前列腺活检的男性中，肥胖男性更年轻，前列腺更大，直肠指检异常的可能性更小。尽管观察到肥胖男性检测率有降低趋势，但多变量分析未发现此类差异，高级别肿瘤发生率也未观察到差异，因此对肥胖在我们病例系列中对前列腺癌检测及病情的影响提出质疑。
