Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England.
Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, England.
Cancer Causes Control. 2020 May;31(5):431-449. doi: 10.1007/s10552-020-01291-3. Epub 2020 Mar 11.
The relationship between body mass index (BMI) and prostate cancer remains unclear. However, there is an inverse association between BMI and prostate-specific antigen (PSA), used for prostate cancer screening. We conducted this review to estimate the associations between BMI and (1) prostate cancer, (2) advanced prostate cancer, and (3) PSA.
We searched PubMed and Embase for studies until 02 October 2017 and obtained individual participant data from four studies. In total, 78 studies were identified for the association between BMI and prostate cancer, 21 for BMI and advanced prostate cancer, and 35 for BMI and PSA. We performed random-effects meta-analysis of linear associations of log-PSA and prostate cancer with BMI and, to examine potential non-linearity, of associations between categories of BMI and each outcome.
In the meta-analyses with continuous BMI, a 5 kg/m increase in BMI was associated with a percentage change in PSA of - 5.88% (95% CI - 6.87 to - 4.87). Using BMI categories, compared to normal weight men the PSA levels of overweight men were 3.43% lower (95% CI - 5.57 to - 1.23), and obese men were 12.9% lower (95% CI - 15.2 to - 10.7). Prostate cancer and advanced prostate cancer analyses showed little or no evidence associations.
There is little or no evidence of an association between BMI and risk of prostate cancer or advanced prostate cancer, and strong evidence of an inverse and non-linear association between BMI and PSA. The association between BMI and prostate cancer is likely biased if missed diagnoses are not considered.
体重指数（BMI）与前列腺癌之间的关系尚不清楚。然而，BMI 与前列腺特异性抗原（PSA）呈负相关，PSA 用于前列腺癌筛查。我们进行了这项综述，以评估 BMI 与（1）前列腺癌、（2）晚期前列腺癌和（3）PSA 之间的关系。
我们在 PubMed 和 Embase 上进行了检索，检索时间截至 2017 年 10 月 2 日，并从四项研究中获取了个体参与者数据。共确定了 78 项关于 BMI 与前列腺癌的相关性研究，21 项关于 BMI 与晚期前列腺癌的相关性研究，35 项关于 BMI 与 PSA 的相关性研究。我们对 PSA 和前列腺癌与 BMI 的线性关联进行了随机效应荟萃分析，并检查了 BMI 类别与每个结局之间关联的潜在非线性。
在 BMI 连续的荟萃分析中，BMI 增加 5kg/m2 与 PSA 降低 5.88%（95%CI-6.87 至-4.87）相关。使用 BMI 类别，与正常体重的男性相比，超重男性的 PSA 水平低 3.43%（95%CI-5.57 至-1.23），肥胖男性的 PSA 水平低 12.9%（95%CI-15.2 至-10.7）。前列腺癌和晚期前列腺癌的分析几乎没有或没有证据表明存在相关性。
BMI 与前列腺癌或晚期前列腺癌的风险之间几乎没有或没有关联，而 BMI 与 PSA 之间存在显著的负相关和非线性关联。如果不考虑漏诊，BMI 与前列腺癌之间的关联可能存在偏倚。
