The association between obesity, diabetes and prostate cancer aggressiveness in Louisiana Cohort.

Introduction Prostate cancer is the most common cancer in men the United States and Louisiana ranks third for prostate cancer mortality rates in the US. With over 40 % adult obesity rates, Louisiana ranks fourth among states for obesity rates. There is conflicting literature on the association between obesity, diabetes and PCa development. We aim to assess if there is an association between obesity, diabetes and PCa aggressiveness at the time of diagnosis, and if this association is modified by race or obesity status. Methods Cases of primary invasive locoregional prostate cancer diagnosed in 2011-2020 were obtained from Louisiana Tumor Registry. PCa aggressiveness was defined in accordance with the TNM stage and Gleason score. Obesity was defined as BMI of 30 or higher, and type 2 diabetes was identified using ICD-10 codes. Linear trends were assessed with Cochran-Armitage Trend tests and highly aggressive disease at diagnosis was modeled using logistic regression. Analyses were performed overall and stratified by race. Results The study included 22,554 cases. Most cases were white (62%), while 35% were Black, and 2% were Hispanic. The overall distribution of PCa aggressiveness was low (23%), intermediate (47%), and high (30%). PCa aggressiveness was significantly associated with older age, Black race, obesity, and diabetes (p<.001). Stratified by race, the relationship between diabetes and aggressiveness was significant among whites (p<.001) and Hispanics (p=0.037) but not Blacks (p=0.398). In multivariable models controlling for age and obesity, diabetes was significantly associated with high PCa aggressiveness among lean white (OR=1.40 (1.18,1.66)) and Hispanic (OR = 2.68 (1.13,6.36)) men, but not among lean (OR=1.08 (0.90,1.29)) or obese (OR= 0.94 (0.78,1.12)) Black men. Conclusion We found that obesity is associated with increased risk of aggressive PCa in both Caucasian and Black men, and Obesity and Diabetes are risk factors that interact in PCa patients. Our ongoing research studies are aimed at assessing the contribution of social, environmental, behavioral, dietary and metabolic risk factors with a special emphasis on epigenetic and metabolic reprogramming for aggressive PCa within the Louisiana Cohort.