Peri-prostatic Fat Volume Measurement as a Predictive Tool for Castration Resistance in Advanced Prostate Cancer

BACKGROUND: Obesity and aggressive prostate cancer (PC) may be linked, but how local peri-prostatic fat relates to tumour response following androgen deprivation therapy (ADT) is unknown. OBJECTIVE: To test if peri-prostatic fat volume (PPFV) predicts tumour response to ADT. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective study on consecutive patients receiving primary ADT. From staging pelvic magnetic resonance imaging scans, the PPFV was quantified with OsirixX 6.5 imaging software. Statistical (univariate and multivariate) analysis were performed using R Version 3.2.1. RESULTS AND LIMITATIONS: Of 224 consecutive patients, 61 with advanced (≥T3 or N1 or M1) disease had (3-mm high resolution axial sections) pelvic magnetic resonance imaging scan before ADT. Median age = 75 yr; median PPFV = 24.8 cm(3) (range, 7.4–139.4 cm(3)). PPFV was significantly higher in patients who developed castration resistant prostate cancer (CRPC; n = 31), with a median of 37.9 cm(3) compared with 16.1 cm(3) (p < 0.0001, Wilcoxon rank sum test) in patients who showed sustained response to ADT (n = 30). Multivariate analysis using Cox proportional hazards models were performed controlling for known predictors of CRPC. PPFV was shown to be independent of all included factors, and the most significant predictor of time to CRPC. Using our multivariate model consisting of all known factors prior to ADT, PPFV significantly improved the area under the curve of the multivariate models receiver operating characteristic analysis. The main study limitation is a relatively small cohort to account for multiple variables, necessitating a future large-scale prospective analysis of PPFV in advanced PC. CONCLUSIONS: PPFV quantification in patients with advanced PC predicts tumour response to ADT. PATIENT SUMMARY: The amount of fat around the prostate predicts prostate cancer response to hormone treatment.