Obesity and aggressive prostate cancer

Butler et al1 have reported a recent “reverse migration” of prostate cancer, beginning in 2012, away from indolent disease toward a more aggressive form. The incidence of localized disease declined across age groups from 2012 to 2015, with the greatest relative declines in low-risk disease. Moreover, the incidence of distant metastatic disease increased gradually during the study period. Joshi and Filson2 comment in an editorial that we may be seeing the longer term effects of the 2012 US Preventive Services Task Force recommendation against routine prostate-specific antigen screening. In fact, we may be witnessing the effect of increasing obesity. Obesity raises the risk of aggressive prostate cancer,3 and the overall prevalence of obesity in men showed a significant upward linear trend in the 12-year period of 1999-2010.4 The Centers for Disease Control and Prevention have declared obesity to be a major public health problem.5, 6 A healthy lifestyle, diet, and exercise may have considerably more impact on prostate cancer morbidity and mortality than routine prostate-specific antigen screening. No specific funding was disclosed. The author made no disclosures.