Association between biomarkers of obesity and risk of high-grade prostatic intraepithelial neoplasia and prostate cancer – Evidence of effect modification by prostate size

Prostate enlargement is common with aging and obesity. We investigated the association between obesity and prostate cancer controlling for differential detection related to prostate enlargement. In an analysis of 500 men, we found body mass index, waist–hip ratio, and blood leptin levels were significantly associated with high-grade PC, but only among men without prostate enlargement. Leptin was also significantly associated with high-grade prostatic intraepithelial neoplasia (HGPIN) in the absence of prostate enlargement. Our results suggest obesity advances prostate carcinogenesis, and that detection biases at prostate biopsy may explain past inconsistencies in the association between obesity and PC.

► Past studies report obesity both increases and decreases risk of PC across different PC cancer stages.
► We found obesity consistently associated with increased PC risk within men without prostate enlargement.
► Results suggest obesity increases PC risk once detection biases at prostate biopsy are addressed.