Prostate cancer harder to spot in obese men

Technical factors unrelated to underlying biology may make prostate cancer more difficult to detect in obese men in their early sixties or younger, researchers report in the Journal of Urology.

“We may be missing some cancers in younger obese men,” lead investigator Dr. Stephen J. Freedland told Reuters Health. “If we are missing some cancers, that means that by the time they are detected, there has been a delay leading to potentially a later-stage cancer. This could contribute to the worse outcomes we have observed among obese men.”

Obesity may be associated with decreased production of the tumor marker prostate specific antigen (PSA) and enlargement of the prostate make detection challenging.

To investigate, Dr. Freedland of Duke University School of Medicine, Durham, North Carolina and colleagues examined the association of body mass index (BMI), the ratio of weight to height used to estimate obesity, prostate weight and PSA in more than 1400 men undergoing radical prostatectomy.

In those younger than 63 years, but not in older men, increasing BMI was associated with increasing prostate weight. There was no significant association between BMI and PSA.

The researchers note that prior studies have shown that larger prostate size is associated with lower cancer detection rates in men undergoing prostate needle biopsy. The degree of enlargement found in younger obese men in the current study, they say, would be expected to result in a 20% to 25% lower chance of detecting prostate cancer.

“Therefore,” Freeland concluded, “we recommend that physicians screen obese men carefully for prostate cancer with a thorough rectal examination and a PSA test.”

SOURCE: Journal of Urology February 2006.

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