Difference in Association of Obesity With Prostate Cancer Risk Between US African American and Non-Hispanic White Men in the Selenium and Vitamin E Cancer Prevention Trial (SELECT) | Cancer Screening, Prevention, Control | JAMA Oncology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Grönberg  H.  Prostate cancer epidemiology.  Lancet. 2003;361(9360):859-864.PubMedGoogle ScholarCrossref
Bostwick  DG, Burke  HB, Djakiew  D,  et al.  Human prostate cancer risk factors.  Cancer. 2004;101(10)(suppl):2371-2490.PubMedGoogle ScholarCrossref
Powell  IJ.  Epidemiology and pathophysiology of prostate cancer in African-American men.  J Urol. 2007;177(2):444-449.PubMedGoogle ScholarCrossref
Gaines  AR, Turner  EL, Moorman  PG,  et al.  The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort.  Cancer Causes Control. 2014;25(8):1029-1035.PubMedGoogle ScholarCrossref
Martin  DN, Starks  AM, Ambs  S.  Biological determinants of health disparities in prostate cancer.  Curr Opin Oncol. 2013;25(3):235-241.PubMedGoogle Scholar
Mordukhovich  I, Reiter  PL, Backes  DM,  et al.  A review of African American-white differences in risk factors for cancer: prostate cancer.  Cancer Causes Control. 2011;22(3):341-357.PubMedGoogle ScholarCrossref
Office of the Surgeon General; Office of Disease Prevention and Health Promotion; Centers for Disease Control and Prevention; National Institutes of Health.  The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001: sect 1. http://www.ncbi.nlm.nih.gov/books/NBK44210/. Accessed March 13, 2015.
Wang  Y, Beydoun  MA.  The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.  Epidemiol Rev. 2007;29:6-28.PubMedGoogle ScholarCrossref
Ogden  CL, Carroll  MD, Kit  BK, Flegal  KM.  Prevalence of childhood and adult obesity in the United States, 2011-2012.  JAMA. 2014;311(8):806-814.PubMedGoogle ScholarCrossref
De Pergola  G, Silvestris  F.  Obesity as a major risk factor for cancer.  J Obes. 2013;2013:291546.PubMedGoogle ScholarCrossref
Roberts  DL, Dive  C, Renehan  AG.  Biological mechanisms linking obesity and cancer risk: new perspectives.  Annu Rev Med. 2010;61:301-316.PubMedGoogle ScholarCrossref
Parekh  N, Lin  Y, Dipaola  RS, Marcella  S, Lu-Yao  G.  Obesity and prostate cancer detection: insights from three national surveys.  Am J Med. 2010;123(9):829-835.PubMedGoogle ScholarCrossref
Hu  MB, Liu  SH, Jiang  HW, Bai  PD, Ding  Q.  Obesity affects the biopsy-mediated detection of prostate cancer, particularly high-grade prostate cancer: a dose-response meta-analysis of 29,464 patients.  PLoS One. 2014;9(9):e106677.PubMedGoogle ScholarCrossref
Discacciati  A, Orsini  N, Wolk  A.  Body mass index and incidence of localized and advanced prostate cancer—a dose-response meta-analysis of prospective studies.  Ann Oncol. 2012;23(7):1665-1671.PubMedGoogle ScholarCrossref
Gong  Z, Neuhouser  ML, Goodman  PJ,  et al.  Obesity, diabetes, and risk of prostate cancer: results from the Prostate Cancer Prevention Trial.  Cancer Epidemiol Biomarkers Prev. 2006;15(10):1977-1983.PubMedGoogle ScholarCrossref
Jackson  MD, Walker  SP, Simpson  CM,  et al.  Body size and risk of prostate cancer in Jamaican men.  Cancer Causes Control. 2010;21(6):909-917.PubMedGoogle ScholarCrossref
Nemesure  B, Wu  SY, Hennis  A, Leske  MC; Prostate Cancer in a Black Population (PCBP) Study Group.  Central adiposity and prostate cancer in a black population.  Cancer Epidemiol Biomarkers Prev. 2012;21(5):851-858.PubMedGoogle ScholarCrossref
Beebe-Dimmer  JL, Dunn  RL, Sarma  AV, Montie  JE, Cooney  KA.  Features of the metabolic syndrome and prostate cancer in African-American men.  Cancer. 2007;109(5):875-881.PubMedGoogle ScholarCrossref
Hayes  RB, Ziegler  RG, Gridley  G,  et al.  Dietary factors and risks for prostate cancer among blacks and whites in the United States.  Cancer Epidemiol Biomarkers Prev. 1999;8(1):25-34.PubMedGoogle Scholar
Klein  EA, Thompson  IM  Jr, Tangen  CM,  et al.  Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT).  JAMA. 2011;306(14):1549-1556.PubMedGoogle ScholarCrossref
Lippman  SM, Goodman  PJ, Klein  EA,  et al.  Designing the Selenium and Vitamin E Cancer Prevention Trial (SELECT).  J Natl Cancer Inst. 2005;97(2):94-102.PubMedGoogle ScholarCrossref
Lippman  SM, Klein  EA, Goodman  PJ,  et al.  Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT).  JAMA. 2009;301(1):39-51.PubMedGoogle ScholarCrossref
World Health Organization. Obesity and Overweight. Fact sheet No. 311. http://www.who.int/mediacentre/factsheets/fs311/en/. Updated January 2015. Accessed March 12, 2015.
Gleason  DF.  Histologic grading of prostate cancer: a perspective.  Hum Pathol. 1992;23(3):273-279.PubMedGoogle ScholarCrossref
Polednak  AP.  Estimating the number of US incident cancers attributable to obesity and the impact on temporal trends in incidence rates for obesity-related cancers.  Cancer Detect Prev. 2008;32(3):190-199.PubMedGoogle ScholarCrossref
Brawley  OW.  Prostate cancer epidemiology in the United States.  World J Urol. 2012;30(2):195-200.PubMedGoogle ScholarCrossref
Vidal  AC, Howard  LE, Moreira  DM, Castro-Santamaria  R, Andriole  GL  Jr, Freedland  SJ.  Obesity increases the risk for high-grade prostate cancer: results from the REDUCE study.  Cancer Epidemiol Biomarkers Prev. 2014;23(12):2936-2942.PubMedGoogle ScholarCrossref
Cao  Y, Ma  J.  Body mass index, prostate cancer-specific mortality, and biochemical recurrence: a systematic review and meta-analysis.  Cancer Prev Res (Phila). 2011;4(4):486-501.PubMedGoogle ScholarCrossref
Kristal  AR, Lampe  JW.  Prioritization of diet and cancer manuscripts: a brief primer.  Cancer Epidemiol Biomarkers Prev. 2011;20(5):725-726.PubMedGoogle ScholarCrossref
Gurel  B, Lucia  MS, Thompson  IM  Jr,  et al.  Chronic inflammation in benign prostate tissue is associated with high-grade prostate cancer in the placebo arm of the prostate cancer prevention trial.  Cancer Epidemiol Biomarkers Prev. 2014;23(5):847-856.PubMedGoogle ScholarCrossref
Beasley  LE, Koster  A, Newman  AB,  et al; Health ABC study.  Inflammation and race and gender differences in computerized tomography-measured adipose depots.  Obesity (Silver Spring). 2009;17(5):1062-1069.PubMedGoogle ScholarCrossref
Hsing  AW, Chua  S  Jr, Gao  YT,  et al.  Prostate cancer risk and serum levels of insulin and leptin: a population-based study.  J Natl Cancer Inst. 2001;93(10):783-789.PubMedGoogle ScholarCrossref
Velasquez-Mieyer  PA, Cowan  PA, Umpierrez  GE, Lustig  RH, Cashion  AK, Burghen  GA.  Racial differences in glucagon-like peptide-1 (GLP-1) concentrations and insulin dynamics during oral glucose tolerance test in obese subjects.  Int J Obes Relat Metab Disord. 2003;27(11):1359-1364.PubMedGoogle ScholarCrossref
Powell  IJ, Bollig-Fischer  A.  Minireview: the molecular and genomic basis for prostate cancer health disparities.  Mol Endocrinol. 2013;27(6):879-891.PubMedGoogle ScholarCrossref
Farrell  J, Petrovics  G, McLeod  DG, Srivastava  S.  Genetic and molecular differences in prostate carcinogenesis between African American and Caucasian American men.  Int J Mol Sci. 2013;14(8):15510-15531.PubMedGoogle ScholarCrossref
Fowke  JH, Signorello  LB, Chang  SS,  et al.  Effects of obesity and height on prostate-specific antigen (PSA) and percentage of free PSA levels among African-American and Caucasian men.  Cancer. 2006;107(10):2361-2367.PubMedGoogle ScholarCrossref
Kristal  AR, Chi  C, Tangen  CM, Goodman  PJ, Etzioni  R, Thompson  IM.  Associations of demographic and lifestyle characteristics with prostate-specific antigen (PSA) concentration and rate of PSA increase.  Cancer. 2006;106(2):320-328.PubMedGoogle ScholarCrossref
Culp  S, Porter  M.  The effect of obesity and lower serum prostate-specific antigen levels on prostate-cancer screening results in American men.  BJU Int. 2009;104(10):1457-1461.PubMedGoogle ScholarCrossref
Baillargeon  J, Pollock  BH, Kristal  AR,  et al.  The association of body mass index and prostate-specific antigen in a population-based study.  Cancer. 2005;103(5):1092-1095.PubMedGoogle ScholarCrossref
Bañez  LL, Hamilton  RJ, Partin  AW,  et al.  Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer.  JAMA. 2007;298(19):2275-2280.PubMedGoogle ScholarCrossref
Werny  DM, Thompson  T, Saraiya  M,  et al.  Obesity is negatively associated with prostate-specific antigen in US men, 2001-2004.  Cancer Epidemiol Biomarkers Prev. 2007;16(1):70-76.PubMedGoogle ScholarCrossref
Schwenzer  NF, Machann  J, Schraml  C,  et al.  Quantitative analysis of adipose tissue in single transverse slices for estimation of volumes of relevant fat tissue compartments: a study in a large cohort of subjects at risk for type 2 diabetes by MRI with comparison to anthropometric data.  Invest Radiol. 2010;45(12):788-794.PubMedGoogle ScholarCrossref
Okorodudu  DO, Jumean  MF, Montori  VM,  et al.  Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis.  Int J Obes (Lond). 2010;34(5):791-799.PubMedGoogle ScholarCrossref
Original Investigation
June 2015

Difference in Association of Obesity With Prostate Cancer Risk Between US African American and Non-Hispanic White Men in the Selenium and Vitamin E Cancer Prevention Trial (SELECT)

Author Affiliations
  • 1Department of Psychosocial and Community Health, University of Washington, Seattle
  • 2Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle
  • 3Department of Epidemiology, University of Washington, Seattle
  • 4SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle
  • 5Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio
  • 6University of Colorado Denver School of Medicine, Aurora, Colorado
JAMA Oncol. 2015;1(3):342-349. doi:10.1001/jamaoncol.2015.0513

Importance  African American men have the highest rates of prostate cancer incidence and mortality in the United States. Understanding underlying reasons for this disparity could identify preventive interventions important to African American men.

Objective  To determine whether the association of obesity with prostate cancer risk differs between African American and non-Hispanic white men and whether obesity modifies the excess risk associated with African American race.

Design, Setting, and Participants  Prospective study of 3398 African American and 22 673 non-Hispanic white men who participated in the Selenium and Vitamin E Cancer Prevention Trial (2001-2011) with present analyses completed in 2014.

Main Outcomes and Measures  Total, low-grade (Gleason score <7), and high-grade (Gleason score ≥7) prostate cancer incidence.

Results  With a median (interquartile range) follow-up of 5.6 (1.8) years, there were 270, 148, and 88 cases of total, low-, and high-grade prostate cancers among African American men and a corresponding 1453, 898, and 441 cases in non-Hispanic white men, respectively. Although not associated with risk among non-Hispanic white men, BMI was positively associated with an increase in risk among African American men (BMI, <25 vs ≥35: hazard ratio [HR], 1.49 [95% CI, 0.95, 2.34]; P for trend = .03). Consequently, the risk associated with African American race increased from 28% (HR, 1.28 [95% CI, 0.91-1.80]) among men with BMI less than 25 to 103% (HR, 2.03 [95% CI, 1.38-2.98]) among African American men with BMI at least 35 (P for trend = .03). Body mass index was inversely associated with low-grade prostate cancer risk within non-Hispanic white men (BMI, <25 vs ≥35: HR, 0.80 [95% CI, 0.58-1.09]; P for trend = .02) but positively associated with risk within African American men (BMI, <25 vs ≥35: HR, 2.22 [95% CI, 1.17-4.21]; P for trend = .05). Body mass index was positively associated with risk of high-grade prostate cancer in both non-Hispanic white men (BMI, <25 vs ≥35: HR, 1.33 [95% CI, 0.90-1.97]; P for trend = .01) and African American men, although the increase may be larger within African American men, albeit the racial interaction was not statistically significant (BMI, <25 vs ≥35: HR, 1.81 [95% CI, 0.79-4.11]; P for trend = .02).

Conclusions and Relevance  Obesity is more strongly associated with increased prostate cancer risk among African American than non-Hispanic white men and reducing obesity among African American men could reduce the racial disparity in cancer incidence. Additional research is needed to elucidate the mechanisms underlying the differential effects of obesity in African American and non-Hispanic white men.