OK. I am fat. I wasn’t really fat until I started on a hormone blockade. Well, maybe I was a little over weight before, but I wasn’t fat. So, can I say that my doctors have made me fat?
Despite who is actually at fault, I am the one who will suffer the consequences. I am the person who is at an increased risk for diabetes and heart problems. I am the person who will also suffer the result of being overweight, fat, and have to go out and buy new pants and possibly have my prostate cancer progress more rapidly. Which is worse, having to buy new pants or having my prostate cancer progress?
Two recent studies have demonstrated that my over weight state might actually be worse than having to go shopping.
According to a study reported in the journal Cancer (Volume 109, page 1192) prostate cancer is more likely to spread in men who are obese at diagnosis. The researchers monitored the outcomes of 752 men with local- or regional-stage prostate cancer ranging in age from 40-64. Fourteen percent of the men had tumors with a Gleason score of 7 or higher, 63% were treated with a radical prostatectomy and 72% had PSA levels of 4.0 ng/mL or higher when diagnosed.
The men were followed for 10 years, obese men (body mass index of 30 or higher) were more than three times as likely to have developed metastases and were more than twice as likely to have died of prostate cancer as opposed to their nonobese counterparts.
The researchers even took into account factors that could have increased the likelihood of prostate cancer spread and death. The poorer outcomes in obese men may be related to alterations in sex hormones, increases in cancer-promoting substances like leptin, or high levels of inflammatory molecules, all of which are associated with excess body fat.
Researchers at the British Journal of Urology International (volume 100, page 315) also concluded that prostate cancer treated by radiation therapy is more likely to recur in men who are obese. In this study 706 men were assessed with localized prostate cancer treated with radiotherapy.
The average age at diagnosis in this study was 72 years. These men were monitored for nearly eight years. Normal weight was defined as a body mass index (BMI) of less than 25; overweight, 25-29.9; and obese, 30 or higher. About 28% of the men were normal weight; slightly more than half were overweight, and about 22% were obese. The obese men had been diagnosed at a younger age than the nonobese men, but they were similar in terms of disease stage, pretreatment PSA level, and Gleason score. None had received androgen-deprivation therapy.
The results showed that the average time to biochemical recurrence (relapse of prostate cancer detected by a rising PSA level) was 93 months for normal-weight men, 88 months for overweight men, and 84 months for obese men.
These studies do not tell us if losing weight can lower your risk of a relapse of prostate cancer if you’re already obese. However it does show that obesity is a major health concern that affects more than your just your heart and diabetes status.
So, should I lose weight? Of course the answer is yes. But will I lose weight? That is the golden question. At this time I am pleased when I go to the doctor and I have not gain weight, but I guess this isn’t good enough.
Joel T Nowak MA, MSW
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