The growing implications of obesity for prostate cancer risk and mortality: where do we go from here?
The growing implications of obesity for prostate cancer risk and mortality: where do we go from here?
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肥胖对前列腺癌风险和死亡率的影响越来越大：我们该何去何从？
DOI：
10.1093/jnci/djad140
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Gresham,Gillian
中科院分区：
文献类型：
--
作者：
Daniels,JamesPercy;Freedland,StephenJ;Gresham,Gillian
肥胖倾向于通过增加发病率，促进进展和降低生存率的方式在多个器官中煽动癌症的火焰（1）。关于前列腺癌，肥胖通常与死亡率和晚期疾病的风险增加有关，尽管最后一个概念仍然存在争议。问题仍然是什么导致肥胖和晚期前列腺癌之间的关联;肥胖是否传播了一种驱动侵袭性前列腺癌的分子机制;或者肥胖是否导致未检查的延迟诊断，导致患者最终出现更晚期的疾病。基于前列腺特异性抗原（PSA）的前列腺癌筛查确实挽救了许多生命，但由于担心过度诊断和过度治疗（即广泛筛查的“危害”），它仍然存在争议，可能未得到充分利用。虽然一些研究表明，肥胖患者更有可能接受PSA筛查，但我们也知道，体重指数（BMI）较高的人的PSA水平被稀释，给他们一种虚假的安全感（2）。所有这一切都回避了一个问题：如果每年的前列腺癌筛查是普遍的，前列腺癌仍然与晚期前列腺癌和相关死亡率的较高风险相关吗？在本期杂志中，Hurwitz和他的同事们试图通过一个独特的研究人群来回答这个问题。在前列腺、肺、结直肠和卵巢（PLCO）癌症筛查试验的（即筛查）组中，Hurwitz等人评估了BMI、晚期前列腺癌，和前列腺癌特异性死亡率在几乎普遍筛查的人群中（3）。无前列腺癌、结直肠癌或肺癌病史的中老年男性被随机分配接受相同的前列腺筛查方案。具体来说，男性每年接受PSA检测5年，其中前3年他们还接受了每年的直肠指检。如果数值大于4 ng/mL，则认为PSA筛查为阳性，如果临床医生遇到任何不对称、解剖标志丢失、结节或硬结，则认为直肠指检为阳性。在较高BMI下观察到的一些值得注意的特征包括年龄较小，当前吸烟者的机会较少，以及合并糖尿病的可能性较高。关于前列腺癌筛查和
Obesity tends to fan the flames of cancer in multiple organs by way of increasing incidence, promoting progression, and decreasing survival (1). With respect to prostate cancer, obesity is often tied to an increased risk of mortality and advanced disease, though the last notion is still debated. Questions remain about what causes the association between obesity and advanced prostate cancer; whether obesity propagates a molecular mechanism that drives aggressive prostate cancer; or whether obesity leads to delayed diagnoses that are left unchecked, resulting in patients ultimately presenting with more advanced disease. Prostate-specific antigen (PSA)–based prostate cancer screening has certainly saved many lives, but it remains controversial and possibly underutilized because of concerns about overdiagnosis and overtreatment (ie, the “harms” from widespread screening). Although some research suggests that obese patients are more likely to undergo PSA screening, we also know that PSA levels from people with a higher body mass index (BMI) are diluted, giving them a false sense of security (2). All this begs the question: if annual prostate cancer screening were universal, would prostate cancer still be associated with a higher risk of advanced prostate cancer and related mortality? In this issue of the Journal, Hurwitz and colleagues (3) seek to answer this question using a unique study population.In an analysis of 36 756 men enrolled between 1993 and 2001 in the intervention (ie, screening) arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, Hurwitz et al. evaluated associations between BMI, advanced prostate cancer, and prostate cancer-specific mortality in an almost universally screened population (3). Middle-aged and older men with no history of prostate, colorectal, or lung cancer were randomly assigned to receive the same prostate screening protocol. Specifically, men underwent annual PSA testing for 5years, for the first 3 years of which they also received an annual digital rectal examination. PSA screening was considered positive if values were greater than 4 ng/mL and digital rectal examination considered positive if the clinician encountered any asymmetry, loss of anatomic landmarks, nodularity, or induration. Some noteworthy characteristics observed at higher BMI included younger age, less chance of being a current smoker, and higher likelihood of comorbid diabetes. Regarding prostate cancer screening and
影响因子：
28.4
作者：
Barrington WE;Schenk JM;Etzioni R;Arnold KB;Neuhouser ML;Thompson IM Jr;Lucia MS;Kristal AR
通讯作者：
Kristal AR