Prostate Cancer Surgery Outcomes Worse in Obese Men

Abdominal obesity is associated with an increased likelihood of surgical complications and worse functional outcomes in men undergoing radical prostatectomy (RP) for prostate cancer (PCa), according to new findings.

Mauro Gacci, MD, of the University of Florence in Italy, and colleagues studied 470 men, of whom 131 (27.8%) had abdominal obesity, defined as a waist circumference (WC) of 102 cm or more. After adjusting for potential confounding factors, these men had a threefold greater risk of intraoperative complications and need for blood transfusions compared with men who had a WC below 102 cm, investigators reported online in the Scandinavian Journal of Urology. The study also revealed a significant positive correlation between abdominal obesity and postoperative urinary incontinence severity. The men with a WC of at least 102 cm had a 2.4 times greater risk needing at least two pads per day than men with a WC below 102 cm. Additionally, compared with men who had a WC below 102 cm, those with a greater WC had a twofold increased likelihood of having positive surgical margins.

Dr. Gacci's team found that the mean preoperative International Index of Erectile Function score was significantly higher in the non-obese than the obese men: 18.8 vs. 16.0.

The investigators explained that increased adiposity is associated with PCa aggressiveness, specifically an increased risk of incident high-grade PCa and postoperative biochemical recurrence. In addition, among patients with localized PCa, obesity is associated with an increased risk of prostate enlargement and greater PCa volume at surgery. Thus, in obese patients, the larger prostate volume means a larger cancer volume. The surgeon's discomfort performing RP in such patients may be associated with a difficult procedure and a higher rate of intraoperative complications.

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