Adiposity and prostate cancer survival
File(s)
Author(s)
Cariolou, Margarita
Type
Thesis
Abstract
Background: The number of men with prostate cancer will continue rising despite public health prevention strategies. It is therefore essential to gain additional knowledge on how post-diagnosis modifiable factors might influence survival outcomes. Obesity is a modifiable risk factor of prostate cancer but its association with prostate cancer survival is unclear. The thesis investigated associations between adiposity assessed close to prostate cancer diagnosis and mortality.
Methods: Systematic review and meta-analyses were performed to gain better insights of the literature. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) and UK Biobank cohorts were used to perform individual-level analyses.
Results: Meta-analysis identified a J-shaped association for body mass index (BMI) and all-cause and prostate cancer-specific mortality. A clear positive association was seen for BMI≥28kg/m2 compared to the referent value of 26kg/m2 for all-cause and 24kg/m2 for prostate cancer-specific mortality. Data on adiposity indices apart from BMI was limited. Analyses in EPIC showed positive associations between BMI per 5kg/m2 assessed close to diagnosis and all-cause (Hazard Ratio [HR]=1.30, 95%CI:1.11-1.52, deaths=320) and prostate cancer-specific mortality (HR=1.49, 95%CI:1.21-1.84, deaths=163). Similar positive associations were seen for pre-diagnosis BMI. Less clear positive associations were seen for post-diagnosis BMI, waist, hip circumference, waist-to-hip ratio, but with limited data. Consistent positive associations were seen in the UK Biobank for BMI per 5kg/m2 and all-cause (HR=1.30, 95%CI:1.18-1.44, deaths=680), prostate cancer-specific (HR=1.33, 95%CI:1.15-1.52, deaths=331) and non-prostate cancer mortality (HR=1.28, 95%CI:1.12-1.47, deaths=347). Positive associations were seen in separate analyses of pre- and post-diagnosis BMI, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage.
Conclusions: The thesis provides important evidence that higher adiposity close to prostate cancer diagnosis is associated with poorer survival. The findings could strengthen the evidence-base and provide the impetus for additional research to assist the development of lifestyle recommendations for prostate cancer patients.
Methods: Systematic review and meta-analyses were performed to gain better insights of the literature. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) and UK Biobank cohorts were used to perform individual-level analyses.
Results: Meta-analysis identified a J-shaped association for body mass index (BMI) and all-cause and prostate cancer-specific mortality. A clear positive association was seen for BMI≥28kg/m2 compared to the referent value of 26kg/m2 for all-cause and 24kg/m2 for prostate cancer-specific mortality. Data on adiposity indices apart from BMI was limited. Analyses in EPIC showed positive associations between BMI per 5kg/m2 assessed close to diagnosis and all-cause (Hazard Ratio [HR]=1.30, 95%CI:1.11-1.52, deaths=320) and prostate cancer-specific mortality (HR=1.49, 95%CI:1.21-1.84, deaths=163). Similar positive associations were seen for pre-diagnosis BMI. Less clear positive associations were seen for post-diagnosis BMI, waist, hip circumference, waist-to-hip ratio, but with limited data. Consistent positive associations were seen in the UK Biobank for BMI per 5kg/m2 and all-cause (HR=1.30, 95%CI:1.18-1.44, deaths=680), prostate cancer-specific (HR=1.33, 95%CI:1.15-1.52, deaths=331) and non-prostate cancer mortality (HR=1.28, 95%CI:1.12-1.47, deaths=347). Positive associations were seen in separate analyses of pre- and post-diagnosis BMI, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage.
Conclusions: The thesis provides important evidence that higher adiposity close to prostate cancer diagnosis is associated with poorer survival. The findings could strengthen the evidence-base and provide the impetus for additional research to assist the development of lifestyle recommendations for prostate cancer patients.
Version
Open Access
Date Issued
2025-04-19
Date Awarded
01/11/2025
License URL
Advisor
Tsilidis, Konstantinos K.
Muller, David C.
Chan, Doris S.M.
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)