Body mass index and mortality in prostate cancer patients: a dose–response meta-analysis

Article metrics



Previous studies concerning the association between body mass index (BMI) and mortality in prostate cancer yielded mixed results. We investigated the association by performing a meta-analysis of all available studies.


Relevant studies were identified by searching PubMed and EMBASE to August 2015. We calculated the summary hazard ratio (HR) and 95% confidence interval (CI) using random-effects models. We estimated combined HRs associated with defined increments of BMI, using random-effects meta-analysis and dose–response meta-regression models.


Thirty-seven cohort studies and one case-control study involving 27 38 000 patients of prostate cancer were selected for meta-analysis. The summary results indicated higher prediagnosis BMI but not postdiagnosis BMI was associated with increased risk of death from prostate cancer. An increment of every 5 kg/m2 in prediagnosis BMI was associated with a 15% higher prostate cancer-specific mortality (HR=1.15, 95% CI: 1.07–1.23, P<0.01). Prediagnosis or postdiagnosis BMI showed no effect on all-cause mortality in prostate cancer patients.


In conclusion, higher prediagnosis BMI is associated with a higher risk of death from prostate cancer. Considering the significant heterogeneity among included studies, these findings require confirmation in future studies.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3
Figure 4


  1. 1

    Siegel RL, Miller KD, Jemal A . Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5–29.

  2. 2

    Haque R, Van Den Eeden SK, Wallner LP, Richert-Boe K, Kallakury B, Wang R et al. Association of body mass index and prostate cancer mortality. Obes Res Clin Pract 2014; 8: e374–e381.

  3. 3

    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: 486–501.

  4. 4

    Moher D, Liberati A, Tetzlaff J, Altman DG . Preferred reporting items for systematic reviews and meta–analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264–269.

  5. 5

    Wells G, Shea B, O’Connell D, Robertson J, Peterson J, Welch V et al The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta–analyses, 2010.

  6. 6

    Viechtbauer W . Bias and efficiency of meta–analytic variance estimators in the random–effects model. J Educ Behav Stat 2005; 30: 261–293.

  7. 7

    Raudenbush SW . Analyzing effect sizes: random–effects models. In: Cooper H, Hedges LV, Valentine JC (eds). The handbook of research synthesis and meta–analysis, Vol. 2. Russell Sage Foundation: New York, 2009, pp 295–316.

  8. 8

    Riley RD, Higgins JP, Deeks JJ . Interpretation of random effects meta–analyses. BMJ 2011; 342: d549.

  9. 9

    Gong Z, Agalliu I, Lin DW, Stanford JL, Kristal AR . Obesity is associated with increased risks of prostate cancer metastasis and death after initial cancer diagnosis in middle–aged men. Cancer 2007; 109: 1192–1202.

  10. 10

    Rodriguez C, Patel AV, Calle EE, Jacobs EJ, Chao A, Thun MJ . Body mass index, height, and prostate cancer mortality in two large cohorts of adult men in the United States. Cancer Epidemiol Biomarkers Prev 2001; 10: 345–353.

  11. 11

    Montgomery RB, Goldman B, Tangen CM, Hussain M, Petrylak DP, Page S et al. Association of body mass index with response and survival in men with metastatic prostate cancer: Southwest Oncology Group trials 8894 and 9916. J Urol 2007; 178: 1946–1951.

  12. 12

    Higgins JP, Thompson SG . Quantifying heterogeneity in a meta–analysis. Stat Med 2002; 21: 1539–1558.

  13. 13

    Hedges LV, Pigott TD . The power of statistical tests in meta–analysis. Psychol Methods 2001; 6: 203–217.

  14. 14

    Egger M, Davey Smith G, Schneider M, Minder C . Bias in meta–analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.

  15. 15

    Greenland S, Longnecker MP . Methods for trend estimation from summarized dose–response data, with applications to meta–analysis. Am J Epidemiol 1992; 135: 1301–1309.

  16. 16

    Andersson SO, Wolk A, Bergstrom R, Adami HO, Engholm G, Englund A et al. Body size and prostate cancer: a 20–year follow–up study among 135006 Swedish construction workers. J Natl Cancer Inst 1997; 89: 385–389.

  17. 17

    Gapstur SM, Gann PH, Colangelo LA, Barron-Simpson R, Kopp P, Dyer A et al. Postload plasma glucose concentration and 27–year prostate cancer mortality (United States). Cancer Causes Control 2001; 12: 763–772.

  18. 18

    Huxley R, Ansary-Mohaddam A, Huxley R, Barzi F, Lam TH, Jamrozik K et al. The impact of modifiable risk factors on mortality from prostate cancer in populations of the Asia–Pacific region. Asian Pac J Cancer Prev 2007; 8: 199–205.

  19. 19

    Wright ME, Chang SC, Schatzkin A, Albanes D, Kipnis V, Mouw T et al. Prospective study of adiposity and weight change in relation to prostate cancer incidence and mortality. Cancer 2007; 109: 675–684.

  20. 20

    Ma J, Li H, Giovannucci E, Mucci L, Qiu W, Nguyen PL et al. Prediagnostic body–mass index, plasma C–peptide concentration, and prostate cancer–specific mortality in men with prostate cancer: a long–term survival analysis. Lancet Oncol 2008; 9: 1039–1047.

  21. 21

    Dehal A, Garrett T, Tedders SH, Arroyo C, Afriyie-Gyawu E, Zhang J . Body mass index and death rate of colorectal cancer among a national cohort of U.S. adults. Nutr Cancer 2011; 63: 1218–1225.

  22. 22

    Discacciati A, Orsini N, Andersson SO, Andren O, Johansson JE, Wolk A . Body mass index in early and middle–late adulthood and risk of localised, advanced and fatal prostate cancer: a population–based prospective study. Br J Cancer 2011; 105: 1061–1068.

  23. 23

    Bassett JK, Severi G, Baglietto L, MacInnis RJ, Hoang HN, Hopper JL et al. Weight change and prostate cancer incidence and mortality. Int J Cancer 2012; 131: 1711–1719.

  24. 24

    Moller H, Roswall N, Van Hemelrijck M, Larsen SB, Cuzick J, Holmberg L et al. Prostate cancer incidence, clinical stage and survival in relation to obesity: a prospective cohort study in Denmark. Int J Cancer 2015; 136: 1940–1947.

  25. 25

    Taghizadeh N, Boezen HM, Schouten JP, Schroder CP, Elisabeth de Vries EG, Vonk JM . BMI and lifetime changes in BMI and cancer mortality risk. PLoS One 2015; 10: e0125261.

  26. 26

    Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM et al. Obesity and mortality in men with locally advanced prostate cancer: analysis of RTOG 85–31. Cancer 2007; 110: 2691–2699.

  27. 27

    Merrick GS, Galbreath RW, Butler WM, Wallner KE, Allen ZA, Adamovich E . Obesity is not predictive of overall survival following permanent prostate brachytherapy. Am J Clin Oncol 2007; 30: 588–596.

  28. 28

    Bonn SE, Wiklund F, Sjolander A, Szulkin R, Stattin P, Holmberg E et al. Body mass index and weight change in men with prostate cancer: progression and mortality. Cancer Causes Control 2014; 25: 933–943.

  29. 29

    Chalfin HJ, Lee SB, Jeong BC, Freedland SJ, Alai H, Feng Z et al. Obesity and long–term survival after radical prostatectomy. J Urol 2014; 192: 1100–1104.

  30. 30

    Davies BJ, Smaldone MC, Sadetsky N, Dall'era M, Carroll PR . The impact of obesity on overall and cancer specific survival in men with prostate cancer. J Urol 2009; 182: 112–117.

  31. 31

    Armstrong AJ, Halabi S, de Wit R, Tannock IF, Eisenberger M . The relationship of body mass index and serum testosterone with disease outcomes in men with castration–resistant metastatic prostate cancer. Prostate Cancer Prostat Dis 2009; 12: 88–93.

  32. 32

    Froehner M, Kellner AE, Koch R, Baretton GB, Hakenberg OW, Wirth MP . A combined index to classify prognostic comorbidity in candidates for radical prostatectomy. BMC Urol 2014; 14: 28.

  33. 33

    Cantarutti A, Bonn SE, Adami HO, Gronberg H, Bellocco R, Balter K . Body mass index and mortality in men with prostate cancer. Prostate 2015; 75: 1129–1136.

  34. 34

    Eichholzer M, Bernasconi F, Jordan P, Stahelin HB . Body mass index and the risk of male cancer mortality of various sites: 17–year follow–up of the Basel cohort study. Swiss Med Wkly 2005; 135: 27–33.

  35. 35

    Siddiqui SA, Inman BA, Sengupta S, Slezak JM, Bergstralh EJ, Leibovich BC et al. Obesity and survival after radical prostatectomy: A 10–year prospective cohort study. Cancer 2006; 107: 521–529.

  36. 36

    Schwartz GG, Skinner HG . A prospective study of total and ionized serum calcium and time to fatal prostate cancer. Cancer Epidemiol Biomarkers Prev 2012; 21: 1768–1773.

  37. 37

    Tendulkar RD, Hunter GK, Reddy CA, Stephans KL, Ciezki JP, Abdel–Wahab M et al. Causes of mortality after dose–escalated radiation therapy and androgen deprivation for high–risk prostate cancer. Int J Radiat Oncol Biol Phys 2013; 87: 94–99.

  38. 38

    Viechtbauer W . Conducting meta–analyses in R with the metafor package. J Stat Softw 2010; 36: 1–48.

  39. 39

    Crippa A, Orsini N . Dosresmeta: Performing Multivariate Dose–response Meta–analysis. R Foundation for Statistical Computing: Vienna, Austria, 2013.

  40. 40

    Pettersson A, Lis RT, Meisner A, Flavin R, Stack EC, Fiorentino M et al. Modification of the association between obesity and lethal prostate cancer by TMPRSS2:ERG. J Natl Cancer Inst 2013; 105: 1881–1890.

  41. 41

    Parr CL, Batty GD, Lam TH, Barzi F, Fang X, Ho SC et al. Body–mass index and cancer mortality in the Asia–Pacific Cohort Studies Collaboration: pooled analyses of 424,519 participants. Lancet Oncol 2010; 11: 741–752.

  42. 42

    Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC . Risk factors for prostate cancer incidence and progression in the health professionals follow–up study. Int J Cancer 2007; 121: 1571–1578.

  43. 43

    Halabi S, Small EJ, Vogelzang NJ . Elevated body mass index predicts for longer overall survival duration in men with metastatic hormone–refractory prostate cancer. J Clin Oncol 2005; 23: 2434–2435.

  44. 44

    Calle EE, Rodriguez C, Walker–Thurmond K, Thun MJ . Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625–1638.

  45. 45

    Gozen AS, Akin Y, Ozden E, Ates M, Hruza M, Rassweiler J . Impact of body mass index on outcomes of laparoscopic radical prostatectomy with long–term follow–up. Scand J Urol 2015; 49: 70–76.

  46. 46

    Xu H, Zhang LM, Liu J, Ding GX, Ding Q, Jiang HW . The association between overall survival of prostate cancer patients and hypertension, hyperglycemia, and overweight in Southern China: a prospective cohort study. J Cancer Res Clin Oncol 2013; 139: 943–951.

  47. 47

    Palma D, Pickles T, Tyldesley S . Obesity as a predictor of biochemical recurrence and survival after radiation therapy for prostate cancer. BJU Int 2007; 100: 315–319.

  48. 48

    Halabi S, Ou SS, Vogelzang NJ, Small EJ . Inverse correlation between body mass index and clinical outcomes in men with advanced castration–recurrent prostate cancer. Cancer 2007; 110: 1478–1484.

  49. 49

    Pfitzenmaier J, Pritsch M, Haferkamp A, Jakobi H, Fritsch F, Gilfrich C et al. Is the body mass index a predictor of adverse outcome in prostate cancer after radical prostatectomy in a mid–European study population? BJU Int 2009; 103: 877–882.

  50. 50

    Burton A, Martin R, Galobardes B, Davey Smith G, Jeffreys M . Young adulthood body mass index and risk of cancer in later adulthood: historical cohort study. Cancer Causes Control 2010; 21: 2069–2077.

  51. 51

    Han M, Trock BJ, Partin AW, Humphreys EB, Bivalacqua TJ, Guzzo TJ et al. The impact of preoperative erectile dysfunction on survival after radical prostatectomy. BJU Int 2010; 106: 1612–1617.

  52. 52

    Van Roermund JG, Hinnen KA, Battermann JJ, Witjes JA, Bosch JL, Kiemeney LA et al. Body mass index is not a prognostic marker for prostate–specific antigen failure and survival in Dutch men treated with brachytherapy. BJU Int 2010; 105: 42–48.

  53. 53

    Haggstrom C, Stocks T, Ulmert D, Bjorge T, Ulmer H, Hallmans G et al. Prospective study on metabolic factors and risk of prostate cancer. Cancer 2012; 118: 6199–6206.

  54. 54

    Park JM, Nam JS, Na W, Oh JJ, Lee S, Hong SK et al. Prognostic value of body mass index in korean patients with castration–resistant prostate cancer. Korean J Urol 2012; 53: 761–765.

  55. 55

    Fowke JH, McLerran DF, Gupta PC, He J, Shu XO, Ramadas K et al. Associations of Body Mass Index, Smoking, and Alcohol Consumption With Prostate Cancer Mortality in the Asia Cohort Consortium. Am J Epidemiol 2015; 182: 381–389.

  56. 56

    Gravis G, Boher JM, Fizazi K, Joly F, Priou F, Marino P et al. Prognostic factors for survival in noncastrate metastatic prostate cancer: validation of the glass model and development of a novel simplified prognostic model. Eur Urol 2015; 68: 196–204.

  57. 57

    Mohammed AA, El-Tanni H, Ghanem HM, Farooq MU, El Saify AM, Al-Zahrani AS et al. Impact of body mass index on clinico–pathological parameters and outcome in patients with metastatic prostate cancer. J Egypt Ntl Canc Inst 2015; 27: 155–159.

  58. 58

    Park SM, Lim MK, Shin SA, Yun YH . Impact of prediagnosis smoking, alcohol, obesity, and insulin resistance on survival in male cancer patients: National Health Insurance Corporation Study. J Clin Oncol 2006; 24: 5017–5024.

  59. 59

    Gann PH, Daviglus ML, Dyer AR, Stamler J . Heart rate and prostate cancer mortality: results of a prospective analysis. Cancer Epidemiol Biomarkers Prev 1995; 4: 611–616.

  60. 60

    Arcidiacono B, Iiritano S, Nocera A, Possidente K, Nevolo MT, Ventura V et al. Insulin resistance and cancer risk: an overview of the pathogenetic mechanisms. Exp Diabetes Res 2012; 2012: 789174.

  61. 61

    Collier A, Ghosh S, McGlynn B, Hollins G . Prostate cancer, androgen deprivation therapy, obesity, the metabolic syndrome, type 2 diabetes, and cardiovascular disease: a review. Am J Clin Oncol 2012; 35: 504–509.

  62. 62

    Hoffman MA, DeWolf WC, Morgentaler A . Is low serum free testosterone a marker for high grade prostate cancer? J Urol 2000; 163: 824–827.

Download references

Author information

Correspondence to J Zhao.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Further reading