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Title: Current PSA Threshold in Obese Men Too High, Leads to Aggressive Cancers
URL: http://www.pslgroup.com/dg/2278CA.htm
Doctor's Guide
August 8, 2008

DURHAM, NC -- August 8, 2008 -- Testing men for elevated levels of prostate-specific antigen (PSA) may be biased against obese men, whose PSA levels tend to be deceptively low, thus creating more aggressive cancers in this population by delaying diagnosis, according to 2 studies published in BJU International.

"We know that obese men tend to have lower PSA values than their normal-weight counterparts, possibly caused by larger blood volumes, which dilute the readings," said lead investigator Stephen Freedland, MD, Duke Prostate Center and Durham Veterans Affairs Medical Center, Durham, North Carolina.

"Now we know some of the real implications of this -- that these men are at a disadvantage in terms of prognosis compared to normal-weight men."

The researchers looked at nearly 3,400 men since 2000 to examine the association between body mass index (BMI) and the amount of disease discovered after surgery to remove the prostate. Then, they compared men who had their cancers detected by PSA screening to those who had an abnormal digital rectal exam.

Obese patients whose cancer was diagnosed by PSA testing had more than twice the risk of cancer recurrence after surgery than their normal-weight counterparts. "In contrast, obese men with abnormal digital rectal exams had similar outcomes as normal-weight men," said Dr. Freedland.

Another study by researchers at Duke Prostate Center published in the same issue of the journal provides further substantiation of the concern that obese men have poorer prognoses than normal-weight men.

This study showed that obese men have a higher rate of positive surgical margins after surgery to remove the prostate.

This suggests that prostate cancer surgery is technically more challenging in obese men, making complete tumour removal more difficult, according to lead investigator of the second study Jayakrishnan Jayachandran, MD.

"The least we can do is find a way to level the playing field when it comes to diagnostic tools," Dr. Freedland said.

The researchers are hopeful that these data, coupled with the earlier data on which they build, may be a catalyst to encourage alternative screening methods for obese men or a lower threshold for worrisome PSA levels in obese men.

SOURCE: Duke University Medical Center

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