The association of diabetes and obesity with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study
- 315 Downloads
Few studies have investigated the role of race in the association of diabetes and obesity with prostate cancer aggressiveness. Here we evaluate the independent association between diabetes and obesity with prostate cancer aggressiveness in White Americans and Black Americans.
Our cross-sectional, case-only study consisted of 1,058 White Americans and 991 Black Americans from the North Carolina-Louisiana Prostate Cancer (PCaP) project. Diabetes status was determined by self-report. Obesity was determined using body mass index and calculated based on anthropometric measurements. High aggressive prostate cancer was defined as Gleason sum ≥8, or prostate-specific antigen >20 ng/ml, or Gleason sum = 7 and clinical stage cT3–cT4. The association between diabetes and obesity with high aggressive prostate cancer at diagnosis was evaluated using multivariable logistic regression and adjusted for potential confounders.
Diabetes was not associated with high aggressive prostate cancer in the overall sample (OR 1.04; 95% CI 0.79, 1.37), White Americans (OR 1.00; 95% CI 0.65, 1.57) or Black Americans (OR 1.07; 95% CI 0.75, 1.53). Obesity, independent of diabetes, was positively associated with high aggressive prostate cancer in White Americans (OR 1.98; 95% CI 1.14, 3.43), but not in the overall sample (OR 1.37; 95% CI 0.99, 1.92) or Black Americans (OR 1.09; 95% CI 0.71, 1.67).
Diabetes was not associated with prostate cancer aggressiveness, overall, or in either race group. Obesity, independent of diabetes, was associated with high aggressive prostate cancer only in White Americans.
KeywordsProstrate cancer Aggressiveness Diabetes Obesity Black Americans PCaP
The North Carolina-Louisiana Prostate Cancer Project (PCaP) is carried out as a collaborative study supported by the Department of Defense contract DAMD 17-03-2-0052. The authors thank the staff, advisory committees, and research subjects participating in the PCaP study for their important contributions. Dr. Khan was supported by T32190194 (Colditz) and by the foundation for Barnes Jewish Hospital and by Siteman Cancer Center. This content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Compliance with ethical standards
Conflict of interest
Saira Khan, PhD, MPH was a graduate research assistant in a position funded by GlaxoSmithKline. Dr. Khan’s work in that position is unrelated to this study. All other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Animal rights statement
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 1.Surveillance, Epidemiology, and End Results (2015) SEER cancer statistics factsheets: prostate cancer. National Cancer Institute, Bethesda Maryland http://seer.cancer.gov/statfacts/html/prost.html. Accessed 2 Sept 2015
- 13.Jayachandran J, Aronson WJ, Terris MK, Presti JC Jr, Amling CL, Kane CJ, Freedland SJ (2010) Diabetes and outcomes after radical prostatectomy: are results affected by obesity and race? Results from the shared equal-access regional cancer hospital database. Cancer Epidemiol Biomark Prev 19(1):9–17. doi: 10.1158/1055-9965.epi-09-0777 CrossRefGoogle Scholar
- 16.Banez LL, Hamilton RJ, Partin AW, Vollmer RT, Sun L, Rodriguez C, Wang Y, Terris MK, Aronson WJ, Presti JC Jr, Kane CJ, Amling CL, Moul JW, Freedland SJ (2007) Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer. JAMA 298(19):2275–2280. doi: 10.1001/jama.298.19.2275 CrossRefPubMedGoogle Scholar
- 18.Parker AS, Thiel DD, Bergstralh E, Carlson RE, Rangel LJ, Joseph RW, Diehl N, Karnes RJ (2013) Obese men have more advanced and more aggressive prostate cancer at time of surgery than non-obese men after adjusting for screening PSA level and age: results from two independent nested case–control studies. Prostate Cancer Prostatic Dis 16(4):352–356. doi: 10.1038/pcan.2013.27 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Jayachandran J, Banez LL, Aronson WJ, Terris MK, Presti JC Jr, Amling CL, Kane CJ, Freedland SJ (2009) Obesity as a predictor of adverse outcome across black and white race: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) Database. Cancer 115(22):5263–5271. doi: 10.1002/cncr.24571 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Freedland SJ, Aronson WJ, Kane CJ, Presti JC Jr, Amling CL, Elashoff D, Terris MK (2004) Impact of obesity on biochemical control after radical prostatectomy for clinically localized prostate cancer: a report by the Shared Equal Access Regional Cancer Hospital database study group. J Clin Oncol 22(3):446–453. doi: 10.1200/jco.2004.04.181 CrossRefPubMedGoogle Scholar
- 21.Amling CL, Riffenburgh RH, Sun L, Moul JW, Lance RS, Kusuda L, Sexton WJ, Soderdahl DW, Donahue TF, Foley JP, Chung AK, McLeod DG (2004) Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy. J Clin Oncol 22(3):439–445. doi: 10.1200/jco.2004.03.132 CrossRefPubMedGoogle Scholar
- 26.Schroeder JC, Bensen JT, Su LJ, Mishel M, Ivanova A, Smith GJ, Godley PA, Fontham ET, Mohler JL (2006) The North Carolina-Louisiana Prostate Cancer Project (PCaP): methods and design of a multidisciplinary population-based cohort study of racial differences in prostate cancer outcomes. Prostate 66(11):1162–1176. doi: 10.1002/pros.20449 CrossRefPubMedGoogle Scholar
- 31.National Cancer Institute (2012) Prostate-Specific Antigen (PSA) test. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/detection/PSA. Accessed 21 June 2014
- 32.Spangler E, Zeigler-Johnson CM, Coomes M, Malkowicz SB, Wein A, Rebbeck TR (2007) Association of obesity with tumor characteristics and treatment failure of prostate cancer in African-American and European American men. J Urol 178(5):1939–1944. doi: 10.1016/j.juro.2007.07.021 (Discussion 1945) CrossRefPubMedGoogle Scholar
- 35.Massengill JC, Sun L, Moul JW, Wu H, McLeod DG, Amling C, Lance R, Foley J, Sexton W, Kusuda L, Chung A, Soderdahl D, Donahue T (2003) Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 169(5):1670–1675. doi: 10.1097/01.ju.0000062674.43964.d0 CrossRefPubMedGoogle Scholar
- 47.Ogden CL, Carroll MD, Fryar CD, Flegal KM (2015) Prevalence of obesity among adults and youth: United States, 2011–2014., vol no 219. National Center for Health Statistics, NCHS data brief, no 219. Hyattsville, MDGoogle Scholar
- 48.Centres for Disease Control and Prevention (2015) Age-specific rates of diagnosed diabetes per 100 civilain, non-institutionalized population, by race and sex, United States, 2014. Centers for Disease Control and Prevention, Atlanta. http://www.cdc.gov/diabetes/statistics/prev/national/fig 2004.htm. Accessed 8 Sept 2016