Body mass index and prostate specific antigen levels in Jamaican men.

OBJECTIVE: To investigate the relationship between body mass index (BMI) and prostate specific antigen (PSA) levels in Jamaican men. METHODS: Men, 40-79 years old, attending public and private urology clinics in Kingston, Jamaica were recruited to a case-control study on the role of dietary and lifestyle factors on prostate cancer. Trained interviewers administered questionnaires and measured weight and height using standardized techniques. Blood samples for PSA were measured at a central laboratory using a micro-particle enzyme immunoassay method. Prostate biopsy was used to confirm prostate cancer. Multivariable linear regression was used to examine the relationship between BMI and PSA separately in the cases and controls. RESULTS: Data from 501 men (233 cases and 263 controls) were assessed. Thirty-five per cent of subjects were overweight and 13% were obese. Among cases, the median PSA was 35.3 ng/dL in normal weight, 26.1 ng/dL in overweight and 14.5 ng/dL in obese men (p = 0.02). For controls, median PSA was 2.0 ng/dL in normal weight, 1.3 ng/dL in overweight and 1.1ng/dl in obese men (p = 0.01). Among cases, BMI was negatively associated with PSA (B(SE) per 5 kg/m2 (BMI difference = -0.51 (0.13); p < 0.01) and remained significant after adjustment for age, sexual activity, smoking, use of statins and tumour grade. For controls, the BMI was also inversely related to the PSA (B(SE) per 5 kg/m2 difference -0.17 (0.07)) but the effect became of borderline significance after adjusting for age. CONCLUSIONS: Prostate specific antigen was inversely related to body mass index in Jamaican men with prostate cancer. Clinicians should consider this association when interpreting PSA results.

Clinicopathological features of prostate cancer in Jamaican men.

OBJECTIVE: To document the clinicopathological features of prostate cancer in a cohort of Jamaican men, and to determine which of these features are of prognostic significance in this population. PATIENTS AND METHODS: The clinical and pathological findings in 99 patients with prostate cancer (diagnosed consecutively after biopsy, in the Department of Pathology at the University of the West Indies) between 1993 and 1997 were reviewed retrospectively. Biopsy specimens included 74 needle biopsies and 25 transurethral resection (TUR) specimens. RESULTS: The mean age at diagnosis was 72.3 years and 79 patients (80%) were symptomatic. The median (range, interquartile range) serum prostate-specific antigen (PSA) value at diagnosis was 37 (1-2100, 2-750) ng/mL; 63% of the patients had clinical stage T1 or T2 disease. Most (60%) of the cancers had a Gleason score of 8-10. Perineural invasion was present in a third of cases overall; high-grade prostatic intraepithelial neoplasia and periprostatic involvement were present in 18% and 8% of biopsies, respectively. The median percentage involvement of all biopsy samples was 37%, that for needle biopsies 47% and for TUR specimens 14%. Of the 90 patients with complete follow-up data, 37 (41%) died; the cause was progressive disease in 19 (51%). The mean (sd, range) survival was 41.3 (19.7, 1-73) months. On univariate analysis, age, PSA level, tumour stage, Gleason score, perineural involvement and periprostatic involvement were significantly associated with an increased risk of dying from prostatic cancer; in a multivariate model, PSA and tumour stage (4 vs. 1) were the only independent factors. CONCLUSIONS: The mean PSA values at the time of diagnosis, the median percentage of biopsy involvement by cancer and the number of patients with tumours of high histological grade were comparatively high, probably reflecting the patients' relatively late clinical presentation. Established prognostic markers were predictive of the risk of death from prostate cancer.

Familial study of prostate cancer in Jamaica.

OBJECTIVES: Rates of prostate cancer in Kingston, Jamaica are extremely high (occurring in more than 300 men out of 100,000 in 1989 to 1993). This article addresses the familial aggregation of prostate cancer in Jamaica. Early evidence for familial prostate cancer was found in the Utah Mormon population. Increased risk of prostate cancer in men with a family history of prostate cancer has been consistently observed in subsequent studies. There have been few studies, however, involving black men, who are known to have an overall higher risk of developing prostate cancer. METHODS: Two hundred sixty-three patients with prostate cancer documented by histology were studied. Two hundred sixty-three age-matched control patients were used for comparison. Extensive pedigrees were obtained for both patients with cancer and controls. Data on other malignancies including lung, breast, colon, stomach, and uterine were also collected. RESULTS: The patients with cancer and the controls were comparable with respect to age and family size. Thirty patients with cancer had a first degree relative (ie, brother, father, or son) with prostate cancer compared to 15 controls. The odds ratio is 2.1 (95% confidence interval 1.1 to 4.4). Nine patients with cancer had a second degree relative (ie, grandfather, grandson, or uncle) affected compared to 3 controls. The odds ratio is 3.1 (95% confidence interval 0.8 to 17.8). There was no statistically significant difference in the rates of any of the other cancers studied. CONCLUSIONS: Familial aggregation of prostate cancer is clearly evident in black Jamaican men. A man with one first degree relative with prostate cancer is twice as likely as the general population to develop prostate cancer. In addition, there may be a statistical difference in the risk of developing prostate cancer if an individual has one second degree relative affected.

The epidemiology of prostate cancer in Jamaica.

PURPOSE: Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans. MATERIALS AND METHODS: The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population. RESULTS: The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80% of the cases were pathologically confirmed. Of the patients 30% presented with acute urinary retention, 16% presented with bone metastases, 15% had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42%. Prostate specific antigen was measured in only 7% of cases in 1989 but in 48% of cases by 1994. CONCLUSIONS: These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States.