Obesity and Prostate Cancer Detection: Insights from Three National Surveys

Obese men tend to have lower Prostate Specific Antigen scores, resulting in fewer referrals for biopsies. Consequently, obese men have higher rates of prostate cancer progression. This study recommends that physicians consider a patient’s Body Mass Index when considering a biopsy referral.



Abstract

Background



Previous studies suggest that obesity is associated with higher prostate cancer progression and mortality despite an association with lower prostate cancer incidence. This study aims to better understand these apparently inconsistent relationships among obese men by combining evidence from 3 nationally representative cross-sectional surveys.



Methods



We evaluated relationships between obesity and 1) testosterone concentrations in the Third National Health and Nutrition Examination Survey (NHANES III; n = 845); 2) prostate-specific antigen (PSA) in NHANES 2001-2004 (n = 2458); and 3) prostate biopsy rates in the National Health Interview Survey (NHIS 2000; n = 4789) population. Mean testosterone, PSA concentrations, and biopsy rates were computed for Body Mass Index (BMI) categories.



Results



Testosterone concentrations were inversely associated with obesity (P-trend <.0001) in NHANES III. In NHANES 2001-2004, obese (BMI >35) versus lean (BMI <25) men were less likely to have PSA concentrations that reached the biopsy threshold of >4 ng/mL (3% vs 8%; P <.0001). Among NHIS participants, all BMI groups had similar rates of PSA testing (P = .24). However, among men who had PSA tests, 11% of men with BMI >30 versus 16% with BMI <25, achieved a PSA threshold of 4 ng/mL; P = .01. Furthermore, biopsy rates were lower among men with BMI >30 versus BMI < 25 in NHIS participants (4.6% vs 5.8%; P = .05).



Conclusions



Obesity was associated with lower PSA-driven biopsy rates. These data support further studies to test the hypothesis that obesity affects prostate cancer detection independent of prostate cancer risk by decreasing the PSA-driven biopsy rates.



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-- Niyati Parekh, PhD, RD, Yong Lin, PhD, Robert S. DiPaola, MD, Stephen Marcella, MD, MPH, Grace Lu-Yao, PhD, MPH



This article originally appeared in the September 2010 issue of The American Journal of Medicine.

Balancing Work, Family and Friends, and Lifestyle

Discussing the balance in a person's life resembles conversations about managing stressful times. As I write this, my daughter, Eva, an accountant and tax attorney, is in the final phase of her stressful and very hectic “busy season” as the April 15th tax deadline draws near. Some people think of those stressful times as periods in which their work/life/family–friends balance is unbalanced, and personal and professional fulfillment seems very far away. The stresses in our lives often make us feel uncomfortable, nervous, and anxious. At these times we wish that our daily activities could meld better so that the stress-induced discomfort would fade away, and we would feel more balanced. Each individual has a different sense of what these entities entail, and each of us undoubtedly feels strongly about what causes stress in our life or how to balance work, play, and human relationships.

To read this article in its entirety, please visit our website.

-- Joseph S. Alpert, MD

This article originally appeared in the September 2010 issue of The American Journal of Medicine.

Interactive CME Activities Linked to AJM's Website

Busy physicians can now earn Continuing Medical Education (CME) credits in the comfort of their own homes by accessing multimedia CME programs on the Journal's website.

Currently, 3 CME programs are available on our website:

CME The Foundation Role of Beta Blockers Across the Cardiovascular Disease Spectrum: A Year 2009 Update

CME Managing Gout in the Primary Care Setting: What You and Your Patients Need to Know

CME Fibromyalgia Syndrome: Practical Strategies for Improving Diagnosis and Patient Outcomes

The CME section of the website is updated periodically, so check back for future options or become a subscriber to this blog for Journal updates. Just click on the "subscribe to" button.

Supplements Provide Additional Information to AJM's Audience

You may know that The American Journal of Medicine is published monthly, but do you know that several times a year the Journal also publishes supplements on specific topics?

Supplements are collections of peer-reviewed research papers on a given area of medicine.

To date in 2010, the Journal has published 3 supplements that are available for free on our website.

July 2010
β-Blockers: Mechanistic Explanations for Class Pharmacodynamic and Therapeutic Heterogeneity

April 2010
Respiratory Infections in the Community: Evaluating Current Antibiotic Options

March 2010
Current Issues in the Treatment of Type 2 Diabetes

If your business or organization would like to sponsor a supplement, contact the Journal at editors@amjmed.org for information.

AJM In Press Online Feature Brings You the Latest Research Studies

Want the most recent clinical research studies from The American Journal of Medicine? Check out the in press online section of AJM's website.

As new research studies and reviews are accepted by the Journal, a select few are uploaded to the in press online section in advance of the publication date.

The in press online section also allows authors to be published quickly.

Learning to Write: A Personal Reflection

Many of you have asked me how someone's career can evolve to marry medicine and editing and writing. The story actually begins with learning to read. My father's sister, a frequent visitor in our home, was a first grade teacher who began teaching me to read when I was 3 years old. As a journalism major and later as a career journalist, my mother was chief proofreader and critic of any school writing project. But all that changed when I was 14 years old, and my mother, tiring of typing our school essays, enrolled my brother and me in a summer secretarial school typing class where I learned to touch type without looking at my fingers on the keyboard. At the time I had no idea how important this skill would become. In later years, I often jokingly told my mother that the “best thing she ever did for me was to enroll me in the secretarial typing class.” Although typing is not writing, this skill started to pay off in high school when I wrote for the school newspaper and literary magazine, and found that typing efficiency could lead to better writing and more effective self-editing. My mother continued to encourage me to write both literary and academic essays, and I found great satisfaction in doing so.

I became an editor during my freshman year in college by accident.

To read this article in its entirety, please visit our website.

-- Joseph S. Alpert, MD

This article originally appeared in the August 2010 issue of The American Journal of Medicine.

Prevalence and Characteristics of Tinnitus among US Adults

Although tinnitus is common in the US, little is known about its risk factors. Analysis of more than 14,000 people with self-reported tinnitus revealed that it is more prevalent among older adults, non-Hispanic whites, former smokers, and adults with hypertension, hearing impairment, loud noise exposure or generalized anxiety disorder.

Abstract
Background

Tinnitus is common; however, few risk factors for tinnitus are known.

Methods

We examined cross-sectional relations between several potential risk factors and self-reported tinnitus in 14,178 participants in the 1999-2004 National Health and Nutrition Examination Surveys, a nationally representative database. We calculated the prevalence of any and frequent (at least daily) tinnitus in the overall US population and among subgroups. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for multiple potential confounders.

Results

Approximately 50 million US adults reported having any tinnitus, and 16 million US adults reported having frequent tinnitus in the past year. The prevalence of frequent tinnitus increased with increasing age, peaking at 14.3% between 60 and 69 years of age. Non-Hispanic whites had higher odds of frequent tinnitus compared with other racial/ethnic groups. Hypertension and former smoking were associated with an increase in odds of frequent tinnitus. Loud leisure-time, firearm, and occupational noise exposure also were associated with increased odds of frequent tinnitus. Among participants who had an audiogram, frequent tinnitus was associated with low-mid frequency (OR 2.37; 95% CI, 1.76-3.21) and high frequency (OR 3.00; 95% CI, 1.78-5.04) hearing impairment. Among participants who were tested for mental health conditions, frequent tinnitus was associated with generalized anxiety disorder (OR 6.07; 95% CI, 2.33-15.78) but not major depressive disorder (OR 1.58; 95% CI, 0.54-4.62).

Conclusions

The prevalence of frequent tinnitus is highest among older adults, non-Hispanic whites, former smokers, and adults with hypertension, hearing impairment, loud noise exposure, or generalized anxiety disorder. Prospective studies of risk factors for tinnitus are needed.

To read this article in its entirety, please visit our website.

-- Josef Shargorodsky, MD, Gary C. Curhan, MD, ScD, Wildon R. Farwell, MD, MPH

This article originally appeared in the August 2010 issue of The American Journal of Medicine