Which Obesity Index Best Correlates With Prostate Volume, Prostate-specific Antigen, and Lower Urinary Tract Symptoms?
Department of Urology, Soonchunhyang University, Seoul Hospital, Seoul, Korea. Urology
(Impact Factor: 2.19).
05/2012; 80(1):187-90. DOI: 10.1016/j.urology.2012.04.003
To determine which measurement variable, waist circumference (WC), body mass index (BMI), or waist-to-hip ratio (WHR) is most closely related to the prostate volume (PV), prostate-specific antigen (PSA), and lower urinary tract symptoms (LUTS).
Between January 2010 and September 2011, 1632 consecutive ostensibly healthy Korean men aged 40-69 years who visited our clinic for a prostate checkup were enrolled into the study. Exclusion criteria included pyuria, history of lower urinary tract disorder influencing urination, and a high PSA level of >3.0 ng/mL. All men underwent a detailed clinical evaluation using the International Prostate Symptom Score (I-PSS) questionnaire. Anthropometric measurements were determined. Serum PSA, urinalysis, and transrectal ultrasound were also performed.
Data from 1601 men were analyzed. The mean age was 51.6 years, WC 83.7 cm, BMI 24.8 kg/m(2), PV 24.6 mL, and the mean PSA level was 1.07 ng/mL. Using multivariate analysis, PV most positively associated with WC (P < .001), while PSA level had negatively associated with BMI (P = .036) and no significant association with WC or WHR was noted. There was no significant relationship between various obesity indexes and I-PSS.
Our data showed that PV positively associated with central obesity, as represented by WC. In contrast, serum PSA negatively associated with BMI, which represented overall obesity (ie, hemodilution). Our data also suggested that obesity is not associated with lower urinary tract symptoms in Korean men.
Available from: Ahmed M Elshal
- "In addition, recently the metabolic syndrome and obesity have been shown to influence both PSA levels and PV to a great extent    . Therefore , it was suggested that for an accurate estimation of PV, PSA measurements and obesity indices should be included  . TRUS-based measurements of PV have shown a strong correlation with resected tissue weight (RTW)  , as during TURP only adenomatous tissue is resected. "
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ABSTRACT: To determine the use of the prostate specific antigen (PSA) level and digital rectal examination (DRE) findings to estimate the resected tissue weight (RTW) before transurethral resection of the prostate (TURP).
We retrospectively analysed 983 patients who underwent TURP between December 2006 and December 2012. The primary outcome was the RTW required for clinical improvement, and was not associated with re-intervention. Age, PSA level, body mass index (BMI) and DRE findings were correlated and modelled with the RTW. The DRE result was defined as DREa (small vs. large) or DREb (small vs. moderate vs. large) according to the surgeon's report. Equations to calculate RTW were developed and tested using receiver operating characteristic (ROC) curve analyses.
There were significant correlations between PSA level (r = 0.4, P < 0.001) and RTW, whilst BMI and age showed weak correlations. The median (range) RTW was 45 (7-60) vs. 15 (6-60) g for small vs. large prostates (DREa) (P < 0.001), respectively. Similarly, the median (range) RTW was 11 (6-59) vs. 26.2 (6-60) vs. 42 (7-60) g in small vs. moderate vs. large prostates (DREb) (P < 0.001), respectively. Using PSA level and DREb (model 3) there was a significantly better ability to estimate RTW than using PSA and DREa (model 2) or PSA alone (model 1) based on ROC curve analyses. The equation developed by model 3 (RTW = 1.2 + (1.13 × PSA) + (DREb × 9.5)) had a sensitivity and specificity of 82% and 71% for estimating a RTW of >30 g, and 84% and 63% for estimating a RTW of >40 g, respectively.
The PSA level and DRE findings can be used to predict the RTW before TURP.
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Few studies examined the relationship between obesity and urinary tract infection (UTI), showing inconsistent results. This study aims to examine the association between obesity and UTI, and to assess whether this association is independent of diabetes mellitus and 25(OH)D level.
Using the computerized database of the largest healthcare provider in Israel, we identified a cohort of subjects ≥18years old with available BMI and serum 25(OH)D level measurements between January 2009 and December 2009. The cohort was followed for the first UTI diagnosis from January 2010 through June 2011. Cox proportional hazard model was used to test the relationship between obesity and UTI.
During follow-up, 25,145/110,736 (22.7%) females, and 4032/42,703 (9.4%) males had UTI. The crude HR for UTI in those with BMI≥50 compared to BMI<25 was 2.54 (95% CI, 1.50-4.30) in males and 1.39 (1.14-1.69) in females. After adjusting for age, 25(OH)D level, and history of diabetes mellitus, the HR for UTI in those with BMI≥50 compared to BMI<25 was 2.38 (1.40-4.03) in males and 1.25 (1.03-1.52) in females. The HR for those in the lowest quartile of serum 25(OH)D compared to the highest quartile was 1.23 (1.13-1.35) in males and 0.98 (0.95-1.02) in females. The HR for subjects with diabetes was 1.23 (1.16-1.32) in males, and 1.25 (1.20-1.28) in females.
Obesity is independently associated with UTI particularly in males. Low serum 25(OH)D levels are associated with increased risk of UTI in males.
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ABSTRACT: Multiple single nucleotide polymorphisms (SNPs) associated with prostate cancer (PC) have been reported in statistically robust studies in the past but these require an in-depth mechanistic understanding with respect to the biological pathways leading to disease. The current study was carried out to examine the PC and benign urology disease risk associations with lifestyle, demographic and genetic factors in a group of men between the ages 40-81 years from Auckland, New Zealand. The data presented herein support a significant positive association of PC risk with tobacco smoking, and a negative association with alcohol intake. The BMI was not associated with disease risk. The SRD5A2 rs632148 G allele was associated with PC compared to those with benign urology disease, after adjustments were made for the confounding variables. The Gleason score as well as disease aggressiveness of the PC group showed no association with lifestyle, demographic factors or the SNPs studied. The levels of prostate-specific antigen (PSA) significantly increased with age, smoking status and BMI, and decreased with alcohol consumption. The AKR1C3 rs12529 G allele was significantly associated with lower PSA levels in PC and benign urology disease groups compared to healthy controls. The G allele of the SRD5A2 rs632148 SNP has shown a significant interaction with PSA and a higher Gleason score outcome. Taken together, these findings show the utility of these gene variants and patient lifestyle history, together with the diagnostic serum PSA levels, to collectively enhance the understanding of the clinical-pathological variables of PC. Such information will support the selection of more personalised treatment options for this disease greatly impacting public health.
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