Background: There has been a large body of research on obesity and the risk of prostate cancer (PCa) that has been published recently. However, the epidemiological evidence for such an association has not been consistent. This may be attributed to the nature of case-control and retrospective studies, which generally are more prone to biases. Therefore, we conducted a systematic review of prospective cohort studies to assess the association between obesity and the risk of PCa incidence and death. Methods: A search of the PubMed database and references of published studies (from inception until March 2013) was conducted. Twenty-three eligible studies were identified and included in the systematic review. Results: The evidence from the prospective cohort studies linking obesity with PCa incidence has not been consistent. However, cumulative data is compelling for a strong positive association between obesity and fatal PCa. Conclusions: Obesity is a significant diet-related risk factor for fatal PCa. Further well-constructed, large cohort studies on the potential association between obesity and PCa, as well as on underlying mechanisms, are needed.

Keywords:
Prospective cohort studies, Prostate cancer, Obesity
1.
Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva, World Health Organization, 2009. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf (accessed on March 19, 2013).
2.
Flegal KM, Carroll MD, Ogden CL, Johnson CL: Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002;288:1723-1727.
3.
Peytremann-Bridevaux I, Faeh D, Santos-Eggimann B: Prevalence of overweight and obesity in rural and urban settings of 10 European countries. Prev Med 2007;44:442-446.
4.
Noria SF, Grantcharov T: Biological effects of bariatric surgery on obesity-related comorbidities. Can J Surg 2013;56:47-57.
5.
Adams KF, Leitzmann MF, Albanes D, et al: Body mass and colorectal cancer risk in the NIH-AARP cohort. Am J Epidemiol 2007;166:36-45.
6.
Olson SH, Trevisan M, Marshall JR, et al: Body mass index, weight gain, and risk of endometrial cancer. Nutr Cancer 1995;23:141-149.
7.
Feigelson HS, Jonas CR, Teras LR, et al: Weight gain, body mass index, hormone replacement therapy, and postmenopausal breast cancer in a large prospective study. Cancer Epidemiol Biomarkers Prev 2004;13:220-224.
8.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
9.
Ikuerowo SO, Omisanjo OA, Bioku MJ, Ajala MO, Esho JO: Effect of obesity on serum prostate-specific antigen in Nigerian men. Urol Int 2012;89:52-56.
10.
Castillejos-Molina R, Rodríguez-Covarrubias F, Sotomayor M, Gómez-Alvarado MO, Villalobos-Gollás M, Gabilondo F, Feria-Bernal G: Impact of metabolic syndrome on biochemical recurrence of prostate cancer after radical prostatectomy. Urol Int 2011;87:270-275.
11.
Mundhenk J, Hennenlotter J, Alloussi S, Selbherr D, Martzog JC, Todenhöfer T, Kruck S, Schwentner C, Stenzl A, Schilling D: Influence of body mass index, surgical approach and lymphadenectomy on the development of symptomatic lymphoceles after radical prostatectomy. Urol Int 2013;90:270-276.
12.
Buschemeyer WC 3rd, Freedland SJ: Obesity and prostate cancer: epidemiology and clinical implications. Eur Urol 2007;52:331-343.
13.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6: e1000097.
14.
Dagnelie PC, Schuurman AG, Goldbohm RA, Van den Brandt PA: Diet, anthropometric measures and prostate cancer risk: a review of prospective cohort and intervention studies. BJU Int 2004;93:1139-1150.
15.
Hayden JA, Côté P, Bombardier C: Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 2006;144:427-437.
16.
Häggström C, Stocks T, Ulmert D, Bjørge T, Ulmer H, Hallmans G, Manjer J, Engeland A, Nagel G, Almqvist M, Selmer R, Concin H, Tretli S, Jonsson H, Stattin P: Prospective study on metabolic factors and risk of prostate cancer. Cancer 2012;118:6199-6206.
17.
Bassett JK, Severi G, Baglietto L, MacInnis RJ, Hoang HN, Hopper JL, English DR, Giles GG: Weight change and prostate cancer incidence and mortality. Int J Cancer 2012;131:1711-1719.
18.
Dehal A, Garrett T, Tedders SH, Arroyo C, Afriyie-Gyawu E, Zhang J: Body mass index and death rate of colorectal cancer among a national cohort of U.S. adults. Nutr Cancer 2011;63:1218-1225.
19.
Chamberlain C, Romundstad P, Vatten L, Gunnell D, Martin RM: The association of weight gain during adulthood with prostate cancer incidence and survival: a population-based cohort. Int J Cancer 2011;129:1199-1206.
20.
Burton A, Martin R, Galobardes B, Davey Smith G, Jeffreys M: Young adulthood body mass index and risk of cancer in later adulthood: historical cohort study. Cancer Causes Control 2010;21:2069-2077.
21.
Stocks T, Hergens MP, Englund A, Ye W, Stattin P: Blood pressure, body size and prostate cancer risk in the Swedish Construction Workers cohort. Int J Cancer 2010;127:1660-1668.
22.
Wallström P, Bjartell A, Gullberg B, Olsson H, Wirfält E: A prospective study on dietary fat and incidence of prostate cancer (Malmö, Sweden). Cancer Causes Control 2007;18:1107-1121.
23.
Pischon T, Boeing H, Weikert S, Allen N, Key T, Johnsen NF, Tjønneland A, Severinsen MT, Overvad K, Rohrmann S, Kaaks R, Trichopoulou A, Zoi G, Trichopoulos D, Pala V, Palli D, Tumino R, Sacerdote C, Bueno-de-Mesquita HB, May A, Manjer J, Wallström P, Stattin P, Hallmans G, Buckland G, Larrañaga N, Chirlaque MD, Martínez C, Redondo Cornejo ML, Ardanaz E, Bingham S, Khaw KT, Rinaldi S, Slimani N, Jenab M, Riboli E: Body size and risk of prostate cancer in the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 2008;17:3252-3261.
24.
Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC: Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer 2007;121:1571-1578.
25.
Littman AJ, White E, Kristal AR: Anthropometrics and prostate cancer risk. Am J Epidemiol 2007;165:1271-1279.
26.
Wright ME, Chang SC, Schatzkin A, Albanes D, Kipnis V, Mouw T, Hurwitz P, Hollenbeck A, Leitzmann MF: Prospective study of adiposity and weight change in relation to prostate cancer incidence and mortality. Cancer 2007;109:675-684.
27.
Hubbard JS, Rohrmann S, Landis PK, Metter EJ, Muller DC, Andres R, Carter HB, Platz EA: Association of prostate cancer risk with insulin, glucose, and anthropometry in the Baltimore longitudinal study of aging. Urology 2004;63:253-258.
28.
Engeland A, Tretli S, Bjørge T: Height, body mass index, and prostate cancer: a follow-up of 950000 Norwegian men. Br J Cancer 2003;89:1237-1242.
29.
Rodriguez C, Patel AV, Calle EE, Jacobs EJ, Chao A, Thun MJ: Body mass index, height, and prostate cancer mortality in two large cohorts of adult men in the United States. Cancer Epidemiol Biomarkers Prev 2001;10:345-353.
30.
Lee IM, Sesso HD, Paffenbarger RS Jr: A prospective cohort study of physical activity and body size in relation to prostate cancer risk (United States). Cancer Causes Control 2001;12:187-193.
31.
Schuurman AG, Goldbohm RA, Dorant E, van den Brandt PA: Anthropometry in relation to prostate cancer risk in the Netherlands Cohort Study. Am J Epidemiol 2000;151:541-549.
32.
Andersson SO, Wolk A, Bergström R, Adami HO, Engholm G, Englund A, Nyrén O: Body size and prostate cancer: a 20-year follow-up study among 135006 Swedish construction workers. J Natl Cancer Inst 1997;89:385-389.
33.
Cerhan JR, Torner JC, Lynch CF, Rubenstein LM, Lemke JH, Cohen MB, Lubaroff DM, Wallace RB: Association of smoking, body mass, and physical activity with risk of prostate cancer in the Iowa 65+ Rural Health Study (United States). Cancer Causes Control 1997;8:229-238.
34.
Chyou PH, Nomura AM, Stemmermann GN: A prospective study of weight, body mass index and other anthropometric measurements in relation to site-specific cancers. Int J Cancer 1994;57:313-317.
35.
Le Marchand L, Kolonel LN, Wilkens LR, Myers BC, Hirohata T: Animal fat consumption and prostate cancer: a prospective study in Hawaii. Epidemiology 1994;5:276-282.
36.
Thompson MM, Garland C, Barrett-Connor E, Khaw KT, Friedlander NJ, Wingard DL: Heart disease risk factors, diabetes, and prostatic cancer in an adult community. Am J Epidemiol 1989;129:511-517.
37.
Mills PK, Beeson WL, Phillips RL, Fraser GE: Cohort study of diet, lifestyle, and prostate cancer in Adventist men. Cancer 1989;64:598-604.
38.
Snowdon DA, Phillips RL, Choi W: Diet, obesity, and risk of fatal prostate cancer. Am J Epidemiol 1984;120:244-250.
39.
Kaaks R, Lukanova A, Rinaldi S, et al: Interrelationships between plasma testosterone, SHBG, IGF-I, insulin and leptin in prostate cancer cases and controls. Eur J Cancer Prev 2003;12:309-315.
40.
Pasquali R, Casimirri F, Cantobelli S, et al: Effect of obesity and body fat distribution on sex hormones and insulin in men. Metabolism 1991;40:101-104.
41.
Arisan ED, Arisan S, Atis G, Palavan-Unsal N, Ergenekon E: Serum adipocytokine levels in prostate cancer patients. Urol Int 2009;82:203-208.
42.
Ribeiro R, Lopes C, Medeiros R: The link between obesity and prostate cancer: the leptin pathway and therapeutic perspectives. Prostate Cancer Prostatic Dis 2006;9:19-24.
43.
Calle EE, Kaaks R: Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 2004;4:579-591.
44.
Severi G, Morris HA, MacInnis RJ, et al: Circulating steroid hormones and the risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 2006;15:86-91.
45.
Chen C, Weiss NS, Stanczyk FZ, et al: Endogenous sex hormones and prostate cancer risk: a case-control study nested within the Carotene and Retinol Efficacy Trial. Cancer Epidemiol Biomarkers Prev 2003;12:1410-1416.
46.
Platz EA, Leitzmann MF, Rifai N, et al: Sex steroid hormones and the androgen receptor gene CAG repeat and subsequent risk of prostate cancer in the prostate-specific antigen era. Cancer Epidemiol Biomarkers Prev 2005;14:1262-1269.
47.
Cunha GR, Hayward SW, Wang YZ, et al: Role of the stromal microenvironment in carcinogenesis of the prostate. Int J Cancer 2003;107:1-10.
48.
Hsing AW, Reichardt JK, Stanczyk FZ: Hormones and prostate cancer: current perspectives and future directions. Prostate 2002;52:213-235.
49.
Massengill JC, Sun L, Moul JW, et al: Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 2003;169:1670-1675.
50.
Giovannucci E, Rimm EB, Stampfer MJ, et al: Diabetes mellitus and risk of prostate cancer. Cancer Causes Control 1998;9:3-9.
51.
Will JC, Vinicor F, Calle EE: Is diabetes mellitus associated with prostate cancer incidence and survival? Epidemiology 1999;10:313-318.
52.
Hsing AW, Gao YT, Chua S, et al: Insulin resistance and prostate cancer risk. J Natl Cancer Inst 2003;95:67-71.
53.
Yu H, Rohan T: Role of insulin-like growth factor family in cancer development and progression. J Natl Cancer Inst 2000;92:1472-1489.
54.
Shaneyfelt T, Husein R, Bubley G, Mantzoros CS: Hormonal predictors of prostate cancer: a meta-analysis. J Clin Oncol 2000;18:847-853.
55.
Shuldiner AR, Yang R, Gong DW: Resistin, obesity and insulin resistance - the emerging role of the adipocyte as an endocrine organ. N Engl J Med 2001;345:1345-1346.
56.
Stattin P, Soderberg S, Hallmans G, et al: Leptin is associated with increased prostate cancer risk: a nested case - referent study. J Clin Endocrinol Metab 2001;86:1341-1345.
57.
Somasundar P, Frankenberry KA, Skinner H, et al: Prostate cancer cell proliferation is influenced by leptin. J Surg Res 2004;118:71-82.
58.
Frankenberry KA, Somasundar P, McFadden DW, Vona-Davis LC: Leptin induces cell migration and expression of growth factors in human prostate cancer cells. Am J Surg 2004;188:560-565.
59.
Saglam K, Aydur E, Yilmaz M, Goktas S: Leptin influences cellular differentiation and progression in prostate cancer. J Urol 2003;169:1308-1311.
60.
Statin P, Kaaks R, Johansson R, et al: Plasma leptin is not associated with prostate cancer risk. Cancer Epidemiol Biomarkers Prev 2003;12:474-475.
61.
Chang S, Hursting SD, Contois JH, et al: Leptin and prostate cancer. Prostate 2001;46:62-67.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.