Cao Yin, Giovannucci Edward
Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Recent Results Cancer Res. 2016;208:137-153. doi: 10.1007/978-3-319-42542-9_8.
Prostate cancer is a complex, heterogeneous disease. Factors related to detection, particularly PSA screening, further increase heterogeneity in the manifestation of the disease. It is thus not possible to provide a simple summary of the relationship between obesity and prostate cancer. Findings on obesity, often defined using body mass index (BMI), and total prostate cancer risk have been mixed; however, obesity is relatively consistently associated with a higher risk of aggressive prostate cancer, with aggressiveness defined in various ways (e.g., advanced stage, fatal, poorer prognosis in men with prostate cancer). Many methodologic issues (e.g., influence of PSA screening, detection bias and treatment) need to be thoroughly considered in both existing and future etiologic and prognostic research. Biological mechanisms supporting the link are under investigation, but may involve insulin and IGF axis, sex steroid hormones and alterations in metabolism. Some promising data suggest that molecular sub-types of prostate cancer may offer insights into etiology, but further study is required. A full evaluation of body fatness and weight change over the life course would not only provide insights to the underlying mechanisms but also allow more effective interventions.
前列腺癌是一种复杂的异质性疾病。与检测相关的因素，尤其是前列腺特异性抗原（PSA）筛查，进一步增加了该疾病表现的异质性。因此，不可能简单概括肥胖与前列腺癌之间的关系。关于肥胖（通常用体重指数（BMI）定义）与前列腺癌总体风险的研究结果不一；然而，肥胖与侵袭性前列腺癌风险较高相对一致相关，侵袭性有多种定义方式（如晚期、致命、前列腺癌男性预后较差）。在现有及未来的病因学和预后研究中，许多方法学问题（如PSA筛查的影响、检测偏倚和治疗）都需要充分考虑。支持这种关联的生物学机制正在研究中，但可能涉及胰岛素和胰岛素样生长因子轴、性甾体激素以及代谢改变。一些有前景的数据表明，前列腺癌的分子亚型可能为病因学提供线索，但仍需进一步研究。对一生中身体脂肪和体重变化进行全面评估，不仅能深入了解潜在机制，还能实现更有效的干预。
