Obesity and mortality in men with locally advanced prostate cancer - Analysis of RTOG 85-31

BACKGROUND. Greater body mass index (BMI) is associated with shorter time to prostate-specific antigen (PSA) failure following radical prostatectomy and radiation therapy (RT). Whether BMI is associated with prostate cancer-specific mortality (PCSM) was investigated in a large randomized trial of men treated with RT and androgen deprivation therapy (ADT) for locally advanced prostate cancer. METHODS. Between 1987 and 1992, 945 eligible men with locally advanced prostate cancer were enrolled in a phase 3 trial (RTOG 85-31) and randomized to RT and immediate goserelin or RT alone followed by goserelin at recurrence. Height and weight data were available at baseline for 788 (83%) subjects. Cox regression analyses were performed to evaluate the relations between BMI and all-cause mortality, PCSM, and nonprostate cancer mortality Covariates included age, race, treatment arm, history of prostatectomy, nodal involvement, Gleason score, clinical stage, and BMI. RESULTS. The 5-year PCSM rate for men with BMI <25 kg/m(2) was 6.5%, compared with 13.1% and 12.2% in men with BMI >= 25 to <30 and BMI >= 30, respec tively (Gray's P =.005). In multivariate analyses, greater BMI was significantly associated with higher PCSM (for BMI >= 25 to <30, hazard ratio [HR] 1.52, 95% confidence interval [CI], 1.02-2.27, P =.04; for BMI >= 30, HR 1.64, 95% CI, 1.01-2.66, P =.04). BMI was not associated with nonprostate cancer or all-cause mortality. CONCLUSIONS. Greater baseline BMI is independently associated with higher PCSM in men with locally advanced prostate cancer. Further studies are warranted to evaluate the mechanism(s) for increased cancer-specific mortality and to assess whether weight loss after prostate cancer diagnosis alters disease course.