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Periprostatic fat measured on computed tomography as a marker for prostate cancer aggressiveness.

van Roermund JG, Bol GH, Witjes JA, Ruud Bosch JL, Kiemeney LA, van Vulpen M - World J Urol (2009)

Bottom Line: Several reports found that obesity was associated with prostate cancer (PC) aggressiveness among men treated with radical prostatectomy or radiotherapy.There was a strong significant association between BMI and fat-density and CFT.Logistic regression analysis revealed no statistically significant association between the different fat measurements and the risk of having a high-risk disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. j.g.h.vanroermund@umcutrecht.nl

ABSTRACT

Objective: Several reports found that obesity was associated with prostate cancer (PC) aggressiveness among men treated with radical prostatectomy or radiotherapy. Studies concerning this issue have basically relied on body mass index (BMI), as a marker for general obesity. Because visceral fat is the most metabolic active fat, we sought to evaluate if periprostatic fat measured on a computed tomography (CT) is a better marker than BMI to predict PC aggressiveness in a Dutch population who underwent brachytherapy for localized PC.

Patients and methods: Of the 902 patients who underwent brachytherapy, 725 CT scans were available. Subcutaneous fat thickness (CFT), periprostatic fat area (cm(2)) and fat-density (%) were determined on the CT scan. Patients were stratified into three groups: <25, 25-75 and >75 percentile of the fat-density. Associations between the three fat-density subgroups and BMI and PC aggressiveness were examined.

Results: 237 patients were classified as having normal weight (37.2%), 320 as overweight (50.2%) and 80 as obese (12.6%). There was a strong significant association between BMI and fat-density and CFT. The strongest correlation was seen between BMI and CFT (Pearson r coefficient = 0.71). Logistic regression analysis revealed no statistically significant association between the different fat measurements and the risk of having a high-risk disease.

Conclusions: Periprostatic fat and fat-density as measured with CT were not correlated with PC aggressiveness in patients receiving brachytherapy. However, 31% of the patients with a normal BMI had a fat-density of >75 percentile of the periprostatic fat-density.

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Images demonstrate our method for determining visceral fat distribution and subcutaneous fat thickness on a CT scan. a Transverse section is made at the level of the caput femoris and greater trochanter of the femur. The red line, outlines the total contour area (cm2), in which attenuation is measured. The line is drawn at the back side of the pubic bone, lateral border of obturatorius internus muscle, anterior side of the gluteus maximus muscle and coccyx bone. Within the region of interest the periprostatic fat area (cm2) and the fat-density (%) was calculated. b Transverse section is made at the level of superior pubic ramus. The red line outlines the subcutaneous fat thickness by which the distance between the skin and pubic bone is measured. (cm)
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Fig1: Images demonstrate our method for determining visceral fat distribution and subcutaneous fat thickness on a CT scan. a Transverse section is made at the level of the caput femoris and greater trochanter of the femur. The red line, outlines the total contour area (cm2), in which attenuation is measured. The line is drawn at the back side of the pubic bone, lateral border of obturatorius internus muscle, anterior side of the gluteus maximus muscle and coccyx bone. Within the region of interest the periprostatic fat area (cm2) and the fat-density (%) was calculated. b Transverse section is made at the level of superior pubic ramus. The red line outlines the subcutaneous fat thickness by which the distance between the skin and pubic bone is measured. (cm)

Mentions: Preoperative height and weight data were collected retrospectively by reviewing anaesthesia records. The BMI (kg/m2) was calculated and stratified into three groups according to the WHO, i.e. normal weight (<25), overweight (25–30) and obese (≥30). Only one patient had a BMI value of <18.5 kg/m2, this patient was included in the normal weight group. The CT’s were acquired on a single slice CT (Aura, Philips Medical Systems, Best, The Netherlands), and had an in-plane slice resolution of 0.49 × 0.49 mm with a slice thickness of 3 mm. We used an in-house developed software tool for delineation of the pelvic fat region and the measurement of the subcutaneous fat thickness (CFT, see Fig. 1) [15].Fig. 1


Periprostatic fat measured on computed tomography as a marker for prostate cancer aggressiveness.

van Roermund JG, Bol GH, Witjes JA, Ruud Bosch JL, Kiemeney LA, van Vulpen M - World J Urol (2009)

Images demonstrate our method for determining visceral fat distribution and subcutaneous fat thickness on a CT scan. a Transverse section is made at the level of the caput femoris and greater trochanter of the femur. The red line, outlines the total contour area (cm2), in which attenuation is measured. The line is drawn at the back side of the pubic bone, lateral border of obturatorius internus muscle, anterior side of the gluteus maximus muscle and coccyx bone. Within the region of interest the periprostatic fat area (cm2) and the fat-density (%) was calculated. b Transverse section is made at the level of superior pubic ramus. The red line outlines the subcutaneous fat thickness by which the distance between the skin and pubic bone is measured. (cm)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2966948&req=5

Fig1: Images demonstrate our method for determining visceral fat distribution and subcutaneous fat thickness on a CT scan. a Transverse section is made at the level of the caput femoris and greater trochanter of the femur. The red line, outlines the total contour area (cm2), in which attenuation is measured. The line is drawn at the back side of the pubic bone, lateral border of obturatorius internus muscle, anterior side of the gluteus maximus muscle and coccyx bone. Within the region of interest the periprostatic fat area (cm2) and the fat-density (%) was calculated. b Transverse section is made at the level of superior pubic ramus. The red line outlines the subcutaneous fat thickness by which the distance between the skin and pubic bone is measured. (cm)
Mentions: Preoperative height and weight data were collected retrospectively by reviewing anaesthesia records. The BMI (kg/m2) was calculated and stratified into three groups according to the WHO, i.e. normal weight (<25), overweight (25–30) and obese (≥30). Only one patient had a BMI value of <18.5 kg/m2, this patient was included in the normal weight group. The CT’s were acquired on a single slice CT (Aura, Philips Medical Systems, Best, The Netherlands), and had an in-plane slice resolution of 0.49 × 0.49 mm with a slice thickness of 3 mm. We used an in-house developed software tool for delineation of the pelvic fat region and the measurement of the subcutaneous fat thickness (CFT, see Fig. 1) [15].Fig. 1

Bottom Line: Several reports found that obesity was associated with prostate cancer (PC) aggressiveness among men treated with radical prostatectomy or radiotherapy.There was a strong significant association between BMI and fat-density and CFT.Logistic regression analysis revealed no statistically significant association between the different fat measurements and the risk of having a high-risk disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands. j.g.h.vanroermund@umcutrecht.nl

ABSTRACT

Objective: Several reports found that obesity was associated with prostate cancer (PC) aggressiveness among men treated with radical prostatectomy or radiotherapy. Studies concerning this issue have basically relied on body mass index (BMI), as a marker for general obesity. Because visceral fat is the most metabolic active fat, we sought to evaluate if periprostatic fat measured on a computed tomography (CT) is a better marker than BMI to predict PC aggressiveness in a Dutch population who underwent brachytherapy for localized PC.

Patients and methods: Of the 902 patients who underwent brachytherapy, 725 CT scans were available. Subcutaneous fat thickness (CFT), periprostatic fat area (cm(2)) and fat-density (%) were determined on the CT scan. Patients were stratified into three groups: <25, 25-75 and >75 percentile of the fat-density. Associations between the three fat-density subgroups and BMI and PC aggressiveness were examined.

Results: 237 patients were classified as having normal weight (37.2%), 320 as overweight (50.2%) and 80 as obese (12.6%). There was a strong significant association between BMI and fat-density and CFT. The strongest correlation was seen between BMI and CFT (Pearson r coefficient = 0.71). Logistic regression analysis revealed no statistically significant association between the different fat measurements and the risk of having a high-risk disease.

Conclusions: Periprostatic fat and fat-density as measured with CT were not correlated with PC aggressiveness in patients receiving brachytherapy. However, 31% of the patients with a normal BMI had a fat-density of >75 percentile of the periprostatic fat-density.

Show MeSH
Related in: MedlinePlus