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Does body mass index affect the proper pre-operative grade and stage assessment in patients with prostate cancer
Julia Drewa1, Jan Adamowicz1,2, Kajetan Juszczak1
1Department of Urology and Andrology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland.
Introduction:
Accurate pre-operative assessment of prostate cancer (PCa) grade and stage is critical for determining the optimal treatment strategy and predicting oncological outcomes. Body mass index (BMI) may affect the diagnostic accuracy of pre-operative evaluations.Aim of the study is to investigate whether BMI affects the accuracy of pre-operative grade and stage assessment in patients PCa who undergo robotic-assisted radical prostatectomy (RARP).
Material And Methods:
This retrospective study analyzed 338 patients with PCa who underwent RARP, assessing concordance between preoperative and postoperative tumor grade (ISUP, Gleason) and stage (TNM) across BMI categories. Correlations between BMI and histopathological parameters were examined, and potential risk factors for underestimation in preoperative evaluation were identified.
Results:
The median age and BMI of the cohort was 67 years. The median BMI was 27.4 with 49.7% overweight and 25.6% obese. Upstaging occurred in 56.4% of cases, with concordance in 34.9% and overestimation in 8.7%. Underestimation rates increased progressively with BMI - 51.8% (normal weight), 54.5% (overweight), and 65.4% (obese). Similarly, ISUP grade concordance declined with higher BMI, from 48.7% in normal-weight to 31.2-33.8% in obese patients, paralleled by higher underestimation (34-36% vs 49-54%). Gleason score concordance also fell with increasing BMI, while underestimation rose accordingly. Although BMI correlated weakly with most postoperative pathological parameters, higher BMI was significantly associated with underestimation of grade and stage. Metabolic comorbidities (particularly hypertension and diabetes) further amplified this trend.
Conclusions:
Elevated BMI is associated with a progressively increased risk of underestimating PCa grade and stage during preoperative assessment. The reduced concordance across TNM staging, ISUP grading, and Gleason scoring is observed in obese patient with PCa. Due to the risk of underestimating PCa, patients in this group should be very cautiously selected for active surveillance.
