Obesity, the condition of being considerably overweight, has been shown to be linked to the development of certain cancers.  Prostate cancer is considered to be one of these cancers.  Making matters worse, being obese makes it more difficult to detect prostate cancer.

Increased risk of prostate cancer? 

It is difficult to know exactly what the role of obesity is in the development of prostate cancer.  However, recent research does point to a link, although it may be only in men who are very obese, with a body-mass index of 35 or higher.  It also appears that men who are obese have higher rates of cancer recurrence after initial treatment, suggesting that their cancers are more aggressive. After a careful review of the published literature, researchers at Duke University have now provided solid evidence for what many studies have already suggested; that obesity is linked to worse outcomes in patients with prostate cancer. The data shows that obese men are at increased risk for high-grade, advanced disease, and higher levels of cancer recurrence.

Is detection of prostate cancer more difficult in the obese?

One of the keys of prostate cancer detection is the PSA blood test.  Because obese men are physically larger, they have more blood volume than a lower weight man.  However, prostate cancer doesn’t know this, and produces the same amount of PSA regardless of a man’s size.  As this PSA is diluted in a larger volume of blood, it appears lower than it actually is.  This may be why obese men have more aggressive cancers, because it takes longer for the PSA level to be considered “high” and is thus detected later in the course of the disease.                 

Are treatment options the same for obese men? 

Physical size can make it difficult for obese men to undergo certain procedures, due to higher rate of complications. These outcomes of course vary from one doctor or surgeon to the next.  Furthermore, less complications were seen using robotic prostatectomy compared to open prostatectomy.

What is recommended for obese men with prostate cancer?

The most important piece of advice is to lose weight.  While difficult, it will improve quality and length of life from all causes, including prostate cancer.  Second, pay attention to your PSA, and remember that obese men’s PSA’s may be falsely low.  Thus obese men with borderline PSA levels should be referred to a urologist sooner rather than later, especially if they have family members with prostate cancer.