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Biopsy may Underestimate Prostate Cancer in Obese and Overweight Men

DURHAM, N.C. -- Obese and overweight men who are diagnosed with prostate cancer by biopsy are more likely than healthy weight men to actually have a more aggressive// case of the disease than the biopsy results would indicate, according to a study led by a Duke University Medical Center researcher.

The finding suggests that misleading biopsy results may be causing many obese and overweight men to receive inadequate or inappropriate treatment that is not aggressive enough to combat the true nature of their disease, said study leader Stephen Freedland, M.D., an assistant professor in the Division of Urology and the Duke Prostate Center.

"We already know that it’s more difficult to diagnose prostate cancer in obese men because they have lower levels of prostate-specific antigen, or PSA, a common blood marker for prostate cancer, and because their larger-sized prostates make it more likely for a biopsy to miss the cancer," he said. "These findings further suggest that we could be missing even more high-grade disease among obese men."

Gaining a better understanding of links between biopsies and prostate cancer also may help physicians improve patient treatment, said Freedland, who also holds an appointment in surgery at the Durham Veterans Affairs Medical Center.

"If we can determine through additional biopsies that an obese or overweight man has more aggressive prostate cancer, we can discuss whether the cancer should be treated with more than one approach, such as combining hormonal therapy with radiation, to reduce the risk of the cancer spreading and improve the chances of cure," Freedland said. "We must also keep in mind that even if a well-done biopsy shows low-grade cancer in an obese patient, there is still a reasonable likelihood that the patient may have high-grade disease."

The researchers, from six universities, published the findings in the March 2007 issue of the journal Urology.

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