Low body mass index is associated with adverse oncological outcomes following radical prostatectomy in Korean prostate cancer patients



The purpose of this study was to determine the impact of obesity on clinicopathological features and biochemical recurrence (BCR) following radical prostatectomy (RP) in Korean prostate cancer (PCa) patients.


A single-institutional retrospective analysis was performed on 880 PCa patients treated by RP without neoadjuvant therapy between July 2005 and December 2011. Patients were stratified according to body mass index (BMI) standards for Asian populations: obese (BMI ≥25 kg/m2), overweight (BMI 23–24.9 kg/m2), or normal weight (BMI <23 kg/m2). For analysis, overweight and obese patients were combined (n = 592, BMI ≥23 kg/m2) and compared with normal weight patients (n = 288, BMI <23 kg/m2). BCR was defined as prostate-specific antigen (PSA) ≥0.2 ng/ml following RP.


Normal weight patients tended to be classified into the higher D’Amico risk category with smaller prostate volumes compared with obese and overweight patients. Normal weight patients had higher pathological Gleason scores and were at higher risk of BCR during the mean follow-up of 58.2 months. This translated to a higher 5-year BCR-free survival rate for obese and overweight patients compared with normal weight patients (77.8 vs. 70.3 %; p = 0.017). On multiple Cox-proportional hazards regression analysis incorporating variables of BMI category, PSA, positive surgical margins, pathological T stage, and Gleason score, higher BMI category remained a significant predictor of a lower risk of BCR (HR = 0.634, p = 0.028).


Obese and overweight Korean PCa patients have lower Gleason scores and a reduced risk of BCR compared with normal weight patients. These findings suggest that body fat influences pathological features and oncologic outcomes of PCa.

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  1. 1.

    Ando R, Nagaya T, Hashimoto Y et al (2008) Inverse relationship between obesity and serum prostate-specific antigen level in healthy Japanese men: a hospital-based cross-sectional survey, 2004–2006. Urology 72:561–565

    PubMed  Article  Google Scholar 

  2. 2.

    World Health Organization (2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:1–253

    Google Scholar 

  3. 3.

    Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150

    PubMed  Article  Google Scholar 

  4. 4.

    GLOBOCAN (2008) IARC. http://globocan.iarc.fr/. Accessed 11 Aug 2012

  5. 5.

    Tomaszewski JJ, Chen YF, Bertolet M et al (2013) Obesity is not associated with aggressive pathologic features or biochemical recurrence after radical prostatectomy. Urology 81:992–996

    PubMed  Article  Google Scholar 

  6. 6.

    Freedland SJ, Isaacs WB, Mangold LA et al (2005) Stronger association between obesity and biochemical progression after radical prostatectomy among men treated in the last 10 years. Clin Cancer Res 11:2883–2888

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Amling CL, Kane CJ, Riffenburgh RH et al (2001) Relationship between obesity and race in predicting adverse pathologic variables in patients undergoing radical prostatectomy. Urology 58:723–728

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Narita S, Mitsuzuka K, Yoneyama T et al (2013) Impact of body mass index on clinicopathological outcome and biochemical recurrence after radical prostatectomy. Prostate Cancer Prostatic Dis 16:271–276

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Giovannucci E, Rimm EB, Colditz GA et al (1993) A prospective study of dietary fat and risk of prostate cancer. J Natl Cancer Inst 85:1571–1579

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163

    Article  Google Scholar 

  11. 11.

    Bassett WW, Cooperberg MR, Sadetsky N et al (2005) Impact of obesity on prostate cancer recurrence after radical prostatectomy: data from CaPSURE. Urology 66:1060–1065

    PubMed  Article  Google Scholar 

  12. 12.

    Chun FK, Briganti A, Graefen M et al (2007) Body mass index does not improve the ability to predict biochemical recurrence after radical prostatectomy. Eur J Cancer 43:375–382

    PubMed  Article  Google Scholar 

  13. 13.

    Isbarn H, Jeldres C, Budaus L et al (2009) Effect of body mass index on histopathologic parameters: results of large European contemporary consecutive open radical prostatectomy series. Urology 73:615–619

    PubMed  Article  Google Scholar 

  14. 14.

    Gallina A, Karakiewicz PI, Hutterer GC et al (2007) Obesity does not predispose to more aggressive prostate cancer either at biopsy or radical prostatectomy in European men. Int J Cancer 121:791–795

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Freedland SJ, Aronson WJ, Kane CJ et al (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 22:446–453

    PubMed  Article  Google Scholar 

  16. 16.

    Ribeiro DL, Pinto ME, Rafacho A et al (2012) High-fat diet obesity associated with insulin resistance increases cell proliferation, estrogen receptor, and PI3 K proteins in rat ventral prostate. J Androl 33:854–865

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Landstrom M, Zhang JX, Hallmans G et al (1998) Inhibitory effects of soy and rye diets on the development of Dunning R3327 prostate adenocarcinoma in rats. Prostate 36:151–161

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Holt SK, Kwon EM, Fu R et al (2013) Association of variants in estrogen-related pathway genes with prostate cancer risk. Prostate 73:1–10

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  19. 19.

    Kennelly R, Kavanagh DO, Hogan AM et al (2008) Oestrogen and the colon: potential mechanisms for cancer prevention. Lancet Oncol 9:385–391

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Tomicek NJ, Lancaster TS, Korzick DH (2011) Increased estrogen receptor beta in adipose tissue is associated with increased intracellular and reduced circulating adiponectin protein levels in aged female rats. Gend Med 8:325–333

    PubMed  Article  PubMed Central  Google Scholar 

  21. 21.

    Honma N, Yamamoto K, Ohnaka K et al (2013) Estrogen receptor-beta gene polymorphism and colorectal cancer risk: effect modified by body mass index and isoflavone intake. Int J Cancer 132:951–958

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Thelen P, Wuttke W, Seidlova-Wuttke D (2013) Phytoestrogens selective for the estrogen receptor beta exert anti-androgenic effects in castration resistant prostate cancer. J Steroid Biochem Mol Biol. doi:10.1016/j.jsbmb.2013.06.009

    Google Scholar 

  23. 23.

    Dey P, Strom A, Gustafsson JA (2013) Estrogen receptor beta upregulates FOXO3a and causes induction of apoptosis through PUMA in prostate cancer. Oncogene. doi:10.1038/onc.2013.384

    PubMed  Google Scholar 

  24. 24.

    Turner JV, Agatonovic-Kustrin S, Glass BD (2007) Molecular aspects of phytoestrogen selective binding at estrogen receptors. J Pharm Sci 96:1879–1885

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Andres S, Abraham K, Appel KE et al (2011) Risks and benefits of dietary isoflavones for cancer. Crit Rev Toxicol 41:463–506

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Hedelin M, Bälter KA, Chang ET et al (2006) Dietary intake of phytoestrogens, estrogen receptor-beta polymorphisms and the risk of prostate cancer. Prostate 66:1512–1520

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Gelmann EP (2002) Molecular biology of the androgen receptor. J Clin Oncol 20:3001–3015

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Parsons JK, Carter HB, Platz EA et al (2005) Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy. Cancer Epidemiol Biomarkers Prev 14:2257–2260

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Wake DJ, Strand M, Rask E et al (2007) Intra-adipose sex steroid metabolism and body fat distribution in idiopathic human obesity. Clin Endocrinol 66:440–446

    Article  CAS  Google Scholar 

  30. 30.

    Deurenberg P, Deurenberg-Yap M, Guricci S (2002) Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev 3:141–146

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Sung Joon Hong.

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Koo, K.C., Yoon, Y.E., Rha, K.H. et al. Low body mass index is associated with adverse oncological outcomes following radical prostatectomy in Korean prostate cancer patients. Int Urol Nephrol 46, 1935–1940 (2014). https://doi.org/10.1007/s11255-014-0729-7

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  • Body mass index
  • Obesity
  • Prostate cancer
  • Prostatectomy
  • Treatment outcome