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Body size and the risk of prostate cancer in the multiethnic cohort

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Body size and the risk of prostate cancer in the multiethnic cohort

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Content UNIVERSITY OF SOUTHERN CALIFORNIA
Body Size and the Risk of Prostate Cancer in the Multiethnic Cohort
Department of Preventive Medicine
Thesis submitted for the degree
Masters of Science (Applied Biostatistics and Epidemiology)
Degree conferral date: May 2019
By
Olivia Sattayapiwat

ABSTRACT OF THE THESIS
Body size and the risk of prostate cancer in the Multiethnic Cohort
By Olivia Sattayapiwat

Master of Science in Epidemiology
University of Southern California, 2019
Professor Chris Haiman, Chair

Obesity is increasingly common and widespread in the Western world, with a prevalence of 39.8% in US adults in 2015-
2016. Currently, the evidence regarding the association between anthropometric measures quantifying obesity and
prostate cancer risk has been conflicting. Moreover, little research has been done to explore this association in other
ethnic groups. Here, we conduct a pooled analysis using data of 79,436 men from the Multiethnic cohort, and
accounting for ethnic differences in body composition, investigate the relation between body mass index (BMI) and BMI
at age 21, waist-hip-ratio (WHR), and height, with risk of prostate cancer. Total prostate cancer, as well as risk stratified
by stage, grade, and aggressiveness of disease, were studied. We estimated the relative risk of prostate cancer using Cox
proportional hazards model. With 15 years of follow-up (1993-2018), we identifying 8,333 incident cases of prostate
cancer. High BMI was associated with advanced and aggressive tumors, and this was more evident in the sensitivity
analyses (RR for high grade cancer 1.14, 95% CI: 0.97,1.34, highest vs lowest quartile, p-trend=0.01; RR for aggressive
disease 1.16, 95% CI: 1.0,1.34, highest vs lowest quartile, p-trend=0.01). Moreover, we found that BMI was inversely
associated with localized (RR=0.82, 95% CI: 0.68,0.99, highest vs lowest quartile, p-trend=0.03), low grade (RR=0.75, 95%
CI: 0.62,0.92, highest vs lowest quartile, p-trend 0.0008), and nonaggressive disease (RR=0.77, 95% CI: 0.62,0.95, highest
vs lowest quartile, p-trend=0.0003) in European Americans. High BMI at age 21 was inversely associated with localized
disease (RR=0.93, 95% CI: 0.87,1.0, highest vs lowest quartile, p-trend=0.002), and positively associated with non-
localized disease (RR=1.2, 95% CI: 1.03,1.41, highest vs lowest quartile, p-trend=0.01). Increasing WHR was associated
with advanced and aggressive tumors, although we did not detect a strong linear trend. While tallness appeared to be
associated with increased risk of aggressive tumors, ethnic-specific models showed an inverse relationship between
tallness and non-aggressive prostate cancer in European Americans (RR=0.84, 95% CI: 0.72,0.99, highest vs lowest
quartile, p-trend=0.03). Our study strengthens the evidence that we must consider ethnicity, when we evaluate body
size measurement, and that the influence of body measurement varies by disease subtype.

Roberta McKean-Cowdin
Veronica Wendy Setiawan
Chris Haiman, Committee Chair

University of Southern California
2019

Table of Contents

1. Introduction…………………………………………….…………………………..…………………………….………………..1
2. Materials and Methods…………………………………………………………………………………………..……………1
2.1 Study Population……………………………………………………..………………………….……………………1
2.2 Statistical Analysis ……………………………………………………………………………………………………2
3. Results…………………………………….……………………………………………………………………………………………3
4. Discussion………………………………………………………………………………………………….………………………10
5. References…………………………………….……………………………………………..……………………………………11
6. Supplemental Tables…………………………….……………………………………………………………………………13

List of Tables
Table 1: Descriptive Characteristics by Race/Ethnicity and Diabetes Status (Yes/No) in the
Multiethnic Cohort, Los Angeles, California, and Hawaii, 1993-2018……………………….……………….3
Table 2a: Adjusted relative risk of prostate cancer Associated with Diabetes Status, stratified
by first-degree family history of prostate cancer and ethnic-specific BMI quartiles…….……………3
Table 2b: Adjusted relative risk of prostate cancer Associated with Diabetes Status, stratified
by tumor characteristics………………………………………………………………………………………..…………………4
Table 3: Adjusted relative risks of prostate cancer in relation to body mass index by
race/ethnicity (in ethnic-specific quartiles)………………………………………………………………………………6
Table 4: Adjusted relative risks of prostate cancer in relation to body mass index at age 21 by
race/ethnicity (in ethnic-specific quartiles)………………………………………………..…………………………… 7
Table 5: Adjusted relative risks of prostate cancer in relation to waist-hip ratio by
race/ethnicity (in ethnic-specific quartiles)………………………………………………………………………………8
Table 6: Adjusted relative risks of prostate cancer in relation to height by race/ethnicity in the
race/ethnicity (in ethnic-specific quartiles)………………………………………………………..…………………… 9
Supplementary table 1: Quartile distribution for body measurements by race………………………13
Supplementary table 2: Adjusted relative risks of prostate cancer in relation to body mass
index by race/ethnicity (in ethnic-specific quartiles), excluding the first five years of follow-
up…………………………………………………………………………………………………….……………………………….……14

1. Introduction
Obesity is increasingly common and widespread in the Western world, with a prevalence of 39.8% in US adults in 2015-
2016 [1]. Body size is related to various hormonal and metabolic pathways, and is likely influential on the risk of
developing prostate cancer. Subsequently, diabetes, a common metabolic disorder, is found to be protective against
prostate cancer, even among differing race/ethnic groups [2,11]. Thus, understanding the impact of body size,
accounting for diabetes, on prostate cancer is very important. Body mass index (BMI), is far from a perfect measure of
body size however, and does not account for muscle mass, bone density, and overall body composition. Subsequently,
BMI may not be the most ideal measure of body size to use in order to make inferences on the metabolic state of an
individual. Moreover, there is increasing evidence of the need for ethnic-specific criteria for classification of BMI, when
assessing prostate cancer risk [3,4]. To date, there have been several studies that have compared the effects of body size
and prostate cancer between non-Hispanic whites and African Americans [5-8]. However, little research has been done
to explore this association in other ethnic groups. The MEC provides a unique opportunity to understand the association
between various anthropometric measurements and prostate cancer risk by ethnicity. Here, we consider ethnic
differences in body composition and comprehensively investigate the relation between BMI and BMI at age 21, waist-
hip-ratio (WHR), and height, with risk of prostate cancer by tumor characteristics.
2. Materials and Methods
2.1 Study population
The Multiethnic cohort is a large prospective study that originally enrolled 215,521 men and women from Hawaii and
California during 1993-1996 [9]. Potential cohort members were identified primarily through Department of Motor
Vehicles drivers’ license files in both states, voters’ registration file in Hawaii, and the Health Care Financing
Administration files in California, and were invited to complete a 26-page self-administered questionnaire asking
questions about demographic, diet and personal behaviors (e.g. physical activity), history of prior medical conditions,
and family history of common cancers. A second brief follow-up and third full questionnaire were sent to cohort
members requesting updated information, including information on medical conditions (e.g. diabetes).
BMI, BMI at 21, and height were self-reported on the 1993 baseline questionnaire. WHR information was requested on
the third questionnaire. Diabetes status is based on self-report from any of the 3 questionnaires or from administrative
data, including Medicare claims, California discharge data, and Hawaii health plan linkage [10]. Men with at least one
self-reported T2D diagnosis, or any confirmation by administrative data source, were considered diabetics. The first
report of a T2D diagnosis was considered as the year of discovery (the earliest year, if there is both information from
both self-report and administrative data). Thus, if the first report of T2D is at baseline, year of discovery would be
considered the date of the baseline questionnaire.
Incident cases of prostate cancer were identified by linkage to the Surveillance, Epidemiology, and End Results (SEER)
cancer registries covering the states of Hawaii and California. Linkage with these registries is complete through July 1
st
,
2018, with 8,333 incident cases of invasive prostate cancer identified. Deaths within the cohort are determined from
linkages to the death certificate files in Hawaii and California, supplemented with linkages to the National Death Index,
linkage also complete through July 1
st
2018. In this analyses, we investigate total prostate cancer, as well as risk stratified
by stage, grade, and aggressiveness of disease. Tumor histologic grade was determined according to the Gleason score
system and grouped as follows: low-grade (≤7) vs high-grade (≥8). Disease stage is defined as localized and non-localized
(regional or metastatic) disease. Disease aggressiveness was operationalized as a binary measure where a Gleason score
≤7 and localized disease was considered non-aggressive, whereas a Gleason score ≥8 or non-localized disease was
defined as aggressive.
In this study, our cohort consists of 96,963 African Americans (AA), European Americans (EA), Native Hawaiians (NH),
Japanese Americans (JA), and Latino (LA) males aged 45-75 years at baseline. Exclusion criteria for the current study
includes men not in the 5 main ethnic groups (n=5,944), invalid diet information (n=3,654), a prevalent report of
prostate cancer at baseline (n=2,877) based on self-report or from the SEER registries, and missing information for body
1
mass index (n=590), body mass index at 21 (n=3,170), and educational level (n=882). We also excluded outliers observed
for some variables; for BMI we excluded 135 participants whose BMI were less than 15 or greater than 50; for BMI at 21,
we excluded 282 participants whose BMI were less than 15 or greater than 50). The final sample for the prospective
analysis of the association for BMI, height, and prostate cancer incidence 79,436 participants. A subset of participants
reported their WHR, which was requested at the 3
rd
questionnaire. Outliers were excluded, whose WHR were less than
0.5 or greater than 2. The subsample for the WHR analyses includes 34,075 participants. The informed consent and
study protocol were approved by the institutional review boards at the University of Southern California and the
University of Hawaii.
2.2 Statistical analyses
We used Cox proportional hazards model with age as the time metric and ethnicity included as a strata variable (AA, EA,
NH, JA, LA) was applied to estimate relative risks (RR) and 95% confidence intervals (CIs) of prostate cancer in strata of
Gleason score (low- or high-grade), stage (localized or non-localized), and disease aggressiveness (nonaggressive and
aggressive).
All models included potential confounders selected a priori based on established risk factors and previous findings in the
MEC [2]. For the analyses between anthropometric measures and prostate cancer, we adjusted for age, diabetes,
educational level, and race/ethnicity (in the pooled analyses). For the analyses between diabetes and prostate cancer,
we adjusted for age, BMI, educational level, and race/ethnicity (in the pooled analyses). We further examine the
association of diabetes and prostate cancer, stratified by family history, cancer stage/grade, and ethnic-specific BMI
quartiles. As we had supplemental information from linkage with Medicare/discharge data/state health plan linkage
[10], we used the earliest date of T2D discovery as the date of diagnosis. Subsequently, diabetes was modeled as a time-
varying variable, with only the years with diabetes since cohort entry counted. Thus, if diabetes was reported at baseline
or on a subsequent follow-up questionnaire, exposure would be counted from baseline, or from the follow-up
questionnaire, respectively. If a participant did not report T2D at baseline, but there was an available claims diagnosis
for T2D, exposure is counted from the earliest claims date (if there are multiple) and begins from this date.
Each of the body measures (BMI, BMI at age 21, WHR, and height) were categorized into ethnic-specific quartiles, using
the lowest quartile as the reference group. For analyses with WHR, follow-up time started at return of the 3
rd

questionnaire when the data were collected, which was between 2003-2007. To test for linear trends across categories,
we modeled each of the anthropometric measurements continuously. In a sensitivity analyses, we excluded the first five
years of follow-up to avoid the risk of reverse causality due to disease-related weight loss.
All statistical tests were two-sided, and p<0.05 was considered statistically significant. Statistical analyses were
performed using SAS 9.4 (SAS Institute Inc.).

2
3. Results
Table 1 shows the characteristics of the study sample by race, stratified by diabetes status. Nearly about a third of the
men were considered diabetic. On average, first-degree family history of prostate cancer was higher among non-
diabetics, ranging from 5.7% in Native Hawaiians (vs 5.2% in diabetics) to 9% in African American non-diabetics (also 9%
in diabetics). Moreover, in each population, non-diabetic men were more likely to acquire higher education levels, not
be overweight, and are more physically active than men with diabetes.

Table 2a consistently shows in multivariate analyses across various stratifications, that men with type 2 diabetes had
significantly lower risk of prostate cancer than did men without type 2 diabetes (RR=0.84, 95% CI: 0.8,0.89; p<0.0001).
The inverse association was observed consistently in all 5 populations. We did not observe a significant difference in the
association when stratified by family history of prostate cancer (no family history: RR=0.85, 95% CI: 0.8, 0.9; with a
family history of prostate cancer: RR=0.83, 95% CI: 0.69,0.99). We observed consistent effects by BMI, across ethnic-
specific quartiles (Q1: RR=0.85, 95% CI: 0.74,0.96; Q2: RR=0.88, 95% CI: 0.79,0.98; Q3: 0.85, 95% CI: 0.76,0.94; Q4:
RR=0.81, 95% CI: 0.74,0.9).

Table 1. Descriptive Characteristics by Race/Ethnicity and Diabetes Status (Yes/No) in the Multiethnic Cohort (n=79,436), Los Angeles, California, and Hawaii, 1993-2018
Patient characteristic Total
Yes No Yes No Yes No Yes No Yes No
No. of men 5072 15456 3950 6130 2315 3310 9159 15255 7987 10802 79,436
Mean age, years (SD) 60.8 (8.2) 58.0 (9.1) 62.1 (8.3) 60.6 (9.1) 57.6 (7.9) 55.7 (8.9) 62.1 (8.4) 60.1 (9.5) 60.9 (7.2) 59.2 (8.0)
No. Of prostate cancer cases 487 1334 724 1051 187 239 923 1419 863 1106 8,333
Family history of prostate cancer, %
a
7.5 8.1 9 9 5.2 5.7 6 6.3 5.4 6.1
Body mass index (kg/m^2), %
a
<23 7.6 19.1 9 15.7 4.2 10.7 17.5 28.6 6.6 11.4
23-24.99 13.3 23.7 12.7 19.2 6.6 14.8 22.8 27.4 12.3 18.1
25-29.99 46.9 45.4 47.7 47.8 41.3 46.6 47.2 39 51.5 54.8
30-34.99 23.3 9.8 22.5 14.1 28.6 20.1 10.2 4.5 22.7 13.2
>=35 8.9 2.1 8.1 3.2 19.4 7.9 2.3 0.5 6.9 2.6
Educational level, %
a
<=12 years 28.1 19.9 40.5 29 54.6 46.3 38.6 35.6 65.7 61.9
Some college
or vocational 30.6 29 37.4 37.1 29.2 32.1 31.2 29.8 23.2 24.9
College
graduate 41.3 51.2 22.1 24 16.2 21.7 30.2 34.7 11.1 13.3
Physical activity (hours/week), %
a,b
0 34.3 24.5 39.8 34.7 23 17.9 38.1 32.8 34.7 26.9
>0-1.5 22.6 20.3 24.1 22.5 23.5 19.8 26 25.7 20.5 20.9
>1.5-5 15.9 18 12.8 15 16.4 18.3 14.4 15.9 13.4 15.3
>5 24.5 35.1 18.7 24.1 34.5 42 19.2 23.2 26.5 33
Abbreviation: SD, standard deviation
a
Age standardized (5-year age groups) to the total population included in the study
b
Percentages do not add up to 100% because of missing values
European Americans African Americans Native Hawaiians Japanese Americans Latinos
Table 2a. Relative Risk of Prostate Cancer Associated With Diabetes Status in the MEC (n=79,436), 1993-2018
Relative Risk
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
All men 8103 0.84 0.8,0.89 1780 0.86 0.75,0.99 1680 0.87 0.78,0.98 416 0.82 0.66,1.02 2299 0.85 0.77,0.94 1928 0.81 0.73,0.9
P value <0.0001 0.03 0.02 0.07 0.001 <0.000.1
Family history 809 0.83 0.69,0.99 205 0.84 0.55,1.3 193 0.92 0.65,1.29 38 1.15 0.56,2.39 199 0.71 0.5,1.01 174 0.78 0.54,1.13
P value 0.04 0.44 0.62 0.7 0.054 0.18
No family history 6672 0.85 0.8,0.9 1481 0.88 0.76,1.02 1304 0.85 0.75,0.97 348 0.78 0.61,0.99 1972 0.86 0.77,0.95 1567 0.83 0.74,0.93
P value <0.0001 0.08 0.02 0.04 0.004 0.001
BMI
Ethnic-specific quartiles Q1 1987 0.85 0.74,0.96 434 0.98 0.69,1.4 358 1.07 0.81,1.41 99 0.96 0.57,1.62 594 0.81 0.65,1.01 489 0.89 0.71,1.12
P value 0.001 0.92 0.65 0.89 0.06 0.31
Q2 2132 0.88 0.79,0.98 476 0.84 0.62,1.14 442 0.96 0.76,1.22 111 0.72 0.46,1.13 609 0.77 0.63,0.94 510 0.73 0.59,0.91
P value 0.02 0.26 0.75 0.15 0.01 0.005
Q3 2087 0.85 0.76,0.94 486 0.84 0.65,1.08 470 0.83 0.67,1.03 102 0.62 0.4,0.97 600 0.96 0.8,1.15 492 0.84 0.69,1.03
P value 0.002 0.18 0.1 0.04 0.67 0.1
Q4 1897 0.81 0.74,0.9 384 0.84 0.67,1.06 410 0.76 0.62,0.94 104 1 0.67,1.47 496 0.84 0.7,1.01 437 0.78 0.64,0.95
P value <0.0001 0.15 0.01 0.98 0.06 0.01
*Adjusted by age, body mass index, and education level. Adjusted for race in pooled analysis
Latinos All European Americans African Americans Native Hawaiians Japanese Americans
3
We also observe consistent effects by disease severity (by stage, localized: RR=0.83, 95% CI: 0.78, 0.88; non-localized:
RR=0.82, 95% CI: 0.71,0.94; by grade, Gleason score <=7: RR=0.86, 95% CI: 0.8,0.91; Gleason score >7: RR=0.76, 95% CI:
0.68, 0.85; by risk group, nonaggressive disease: RR=0.85, 95% CI: 0.79,0.91; aggressive disease: RR=0.77, 95% CI:
0.7,0.85) (Table 2b).

Ethnic-specific distributions of BMI, BMI at 21, WHR, and height are presented in supplementary material
(Supplementary Table 1). While we did not detect any linear associations between anthropometric measurements and
all prostate cancer, we found interesting associations in analyses broken down by stage, grade, and aggressiveness of
disease.
We found that high BMI was associated with advanced and aggressive tumors, although we did not detect a strong
linear trend. We also observed that BMI was inversely associated with localized (RR=0.82, 95% CI: 0.68,0.99, highest vs
lowest quartile, p-trend=0.03), low grade (RR=0.75, 95% CI: 0.62,0.92, highest vs lowest quartile, p-trend 0.0008), and
nonaggressive disease (RR=0.77, 95% CI: 0.62,0.95, highest vs lowest quartile, p-trend=0.0003) in EA men (Table 3).
Moreover, we observed a strong association between high BMI and nonaggressive prostate cancer, although this
association was not found to be linear. When censoring 5 years of follow-up of incident cases, while we observed the
same inverse association between BMI and nonaggressive prostate cancer among EA men, there was a strengthened
association observed in increasing BMI with high grade (RR=1.14, 95% CI: 0.97,1.34, highest vs lowest quartile, p-
trend=0.01) and aggressive disease (RR=1.16, 95% CI: 1.0,1.34, highest vs lowest quartile, p-trend=0.01). (Supplementary
Table 2). This appears to be driven by NH men (high grade RR=1.75, 95% CI: 1.02,3.01, highest vs lowest quartile, p-
trend=0.01; aggressive disease RR=1.41, 95% CI: 0.86,2.32, highest vs lowest quartile, p-trend=0.04).
High BMI at age 21 was inversely associated with localized disease (RR=0.93, 95% CI: 0.87,1.0, highest vs lowest quartile,
p-trend=0.002), and positively associated with non-localized disease (RR=1.2, 95% CI: 1.03,1.41, highest vs lowest
quartile, p-trend=0.01). (Table 4). The inverse association with localized disease is driven by EA and JA men (RR in EA
men 0.9, 95% CI: 0.78,1.05, highest vs lowest quartile, p-trend=0.04; RR in JA men 0.88, 95% CI: 0.77,1.0, highest vs
lowest quartile, p-trend=0.03). Moreover, this inverse association appears to be strongly driven by EA men in low-grade
(RR=0.86, 95% CI: 0.73,1.01, highest vs lowest quartile, p-trend=0.02) and nonaggressive disease (RR=0.83, 95% CI:
0.7,0.99, highest vs lowest quartile, p-trend=0.01). The positive association observed with non-localized disease appears
to be driven by JA men (RR=1.64, 95% CI: 1.17,2.29, highest vs lowest quartile, p-trend=0.003).
Increasing WHR was associated with advanced and aggressive tumors, although we did not detect a strong linear trend.
Notably, in EA men, the risk of aggressive disease in relation to increasing WHR is 76% higher in the top quartile,
compared to the bottom quartile (RR=1.76, 95% CI: 0.99,3.12, p-value=0.05). Additionally, we observed high WHR to be
inversely associated with nonaggressive prostate cancer in EA men, with a robust positive association in AA men (Table
5).
While tallness appeared to be associated with increased risk of aggressive tumors, we did not detect a strong linear
trend. However, ethnic-specific models show an inverse relationship between tallness with low-grade cancer (RR=0.84,
95% Ci: 0.73,0.98, highest vs lowest quartile, p-trend=0.01) and non-aggressive prostate cancer (RR=0.84, 95% CI:
Table 2b. Relative Risk of Prostate Cancer Associated With Diabetes Status in the MEC (n=79,436), 1993-2018
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
No. of
cases
Relative
Risk
95% Confidence
Interval
Stage Localized 6342 0.83 0.78,0.88 1404 0.8 0.68,0.93 1289 0.9 0.78,1.02 325 0.77 0.6,0.99 1893 0.85 0.77,0.95 1431 0.78 0.69,0.88
P value <0.0001 0.005 0.1 0.04 0.003 <0.0001
Regional + Distant 1222 0.82 0.71,0.94 287 0.99 0.72,1.38 238 0.64 0.46,0.9 77 1.05 0.64,1.72 303 0.82 0.62,1.07 317 0.8 0.61,1.04
P value 0.005 0.97 0.01 0.85 0.15 0.09
Grade Gleason score <=7 5732 0.86 0.8,0.91 1223 0.89 0.75,1.05 1247 0.88 0.77,1.01 271 0.78 0.59,1.03 1505 0.86 0.77,0.97 1486 0.83 0.74,0.94
P value <0.0001 0.17 0.07 0.08 0.02 0.003
Gleason score >7 1985 0.76 0.68,0.85 464 0.74 0.56,0.96 315 0.8 0.61,1.05 132 0.97 0.67,1.42 724 0.78 0.66,0.93 350 0.65 0.5,0.84
P value <0.0001 0.03 0.1 0.89 0.006 0.001
AgressivenessLow risk group 4891 0.85 0.79,0.91 1079 0.86 0.71,1.02 1043 0.9 0.77,1.04 238 0.82 0.61,1.1 1331 0.87 0.76,0.99 1200 0.8 0.7,0.92
Localized and Low Gleason P value <0.0001 0.09 0.14 0.18 0.03 0.001
High risk group 2420 0.77 0.7,0.85 552 0.76 0.59,0.97 408 0.77 0.61,0.99 155 0.87 0.61,1.24 820 0.81 0.68,0.95 485 0.71 0.57,0.88
Non-localized or High Gleason P value <0.0001 0.03 0.04 0.44 0.01 0.002
*Adjusted by age, body mass index, and education level. Adjusted for race in pooled analysis
Latinos All European Americans African Americans Native Hawaiians Japanese Americans
4
0.72,0.99, highest vs lowest quartile, p-trend=0.03) in EA men (Table 6). The observed inverse association between
tallness and low-grade cancer also appears to be driven by JA men, although the trend is not statistically significant.

5
Table 3. Relative risks of prostate cancer in relation to body mass index by race/ethnicity in the MEC (1993-2018)
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
All Cancers 8103 0.24 1780 0.08 1680 0.3 416 0.28 2299 0.35 1928 0.11
1 1987 ref 5037 ref 358 ref 99 ref 594 ref 489 ref
2 2132 1.03 0.97,1.09 0.38 5156 1.02 0.9,1.16 0.74 442 1.15 1.0,1.32 0.05 111 1.12 0.85,1.46 0.43 609 1 0.89,1.12 1 510 1.01 0.89,1.14 0.91
3 2087 1.01 0.95,1.08 0.74 5112 1.06 0.93,1.21 0.39 470 1.21 1.05,1.39 0.007 102 1.11 0.84,1.48 0.45 600 1.03 0.92,,1.15 0.65 492 0.99 0.87,1.12 0.85
4 1897 0.97 0.91,1.03 0.32 5090 0.9 0.79,1.04 0.16 410 1.09 0.94,1.26 0.25 104 1.24 0.93,1.65 0.15 496 0.96 0.85,1.08 0.46 437 0.95 0.83,1.08 0.44
Stage Localized 6342 0.2 1404 0.05 1289 0.29 325 0.45 1893 0.26 1431 0.26
1 1557 ref 349 ref 265 ref 72 ref 493 ref 357 ref
2 1698 1.05 0.98,1.13 0.15 371 0.99 0.86,1.15 0.92 344 1.21 1.03,1.42 0.02 93 1.28 0.94,1.74 0.12 511 1.01 0.89,1.14 0.89 390 1.06 0.91,1.22 0.47
3 1637 1.03 0.96,1.1 0.45 388 1.05 0.91,1.21 0.51 363 1.26 1.07,1.47 0.005 84 1.26 0.92,1.74 0.15 500 1.03 0.91,1.17 0.65 360 0.99 0.86,1.15 0.92
4 1450 0.97 0.9,1.04 0.36 296 0.87 0.74,1.02 0.08 317 1.12 0.95,1.32 0.18 76 1.26 0.9,1.76 0.18 389 0.9 0.79,1.04 0.14 324 0.97 0.83,1.13 0.68
Regional + Distant 1222 0.4 287 0.8 238 0.7 77 0.53 303 0.19 317 0.6
1 282 ref 54 ref 53 ref 24 ref 66 ref 79 ref
2 299 0.99 0.84,1.17 0.93 87 1.49 1.06,2.09 0.02 63 1.13 0.79,1.63 0.5 14 0.57 0.29,1.1 0.09 71 1.04 0.74,1.45 0.83 69 0.83 0.6,1.15 0.27
3 315 1.02 0.87,1.2 0.8 76 1.31 0.92,1.86 0.13 62 1.13 0.78,1.63 0.52 16 0.68 0.36,1.3 0.25 77 1.14 0.82,1.59 0.43 91 1.1 0.81,1.49 0.55
4 326 1.07 0.91,1.27 0.42 70 1.26 0.88,1.82 0.21 60 1.15 0.79,1.67 0.48 23 1.01 0.55,1.85 0.97 89 1.42 1.02,1.97 0.04 78 0.99 0.72,1.36 0.93
Grade Low Gleason 5732 0.06 1223 0.002 1247 0.16 271 0.93 1505 0.21 1486
1 1384 ref 314 ref 258 ref 63 ref 388 ref 381 ref 0.17
2 1514 1.03 0.96,1.11 0.45 337 1 0.86,1.17 0.98 328 1.18 1.01,1.39 0.04 78 1.23 0.88,1.71 0.23 410 1.02 0.89,1.17 0.81 392 0.99 0.86,1.14 0.86
3 1452 0.97 0.9,1.05 0.45 319 0.96 0.82,1.12 0.57 336 1.2 1.02,1.41 0.03 72 1.22 0.87,1.72 0.26 386 0.99 0.86,1.14 0.91 378 0.96 0.84,1.11 0.61
4 1382 0.95 0.88,1.03 0.23 253 0.8 0.68,0.95 0.01 325 1.17 0.99,1.39 0.06 58 1.07 0.74,1.55 0.73 321 0.91 0.78,1.06 0.21 335 0.92 0.79,1.06 0.24
High Gleason 1985 0.19 464 0.15 315 132 0.03 724 0.76 350 0.4
1 499 ref 91 ref 73 ref 0.8 32 ref 184 ref 83 ref
2 527 1.07 0.95,1.21 0.29 119 1.23 0.93,1.61 0.15 78 1.01 0.73,1.39 0.96 30 0.92 0.56,1.52 0.75 183 0.99 0.81,1.22 0.94 99 1.17 0.88,1.57 0.28
3 532 1.16 1.02,1.31 0.02 147 1.55 1.19,2.02 0.001 98 1.27 0.94,1.72 0.13 27 0.9 0.53,1.51 0.68 198 1.13 0.93,1.39 0.22 84 1.03 0.76,1.4 0.85
4 427 1.03 0.9,1.18 0.67 107 1.26 0.94,1.67 0.12 66 0.89 0.63,1.25 0.49 43 1.53 0.95,2.48 0.08 159 1.05 0.85,1.31 0.64 84 1.15 0.84,1.56 0.39
Aggressiveness Low risk group 4891 0.06 1079 0.003 1043 0.2 238 0.89 1331 0.2 1200 0.22
1 1190 ref 281 ref 209 ref 54 ref 343 ref 309 ref
2 1300 1.04 0.96,1.12 0.38 295 0.98 0.83,1.15 0.79 278 1.24 1.04,1.48 0.02 69 1.27 0.88,1.81 0.2 370 1.04 0.89,1.2 0.64 320 1 0.85,1.17 0.97
3 1249 0.99 0.91,1.07 0.74 279 0.93 0.79,1.1 0.42 288 1.27 1.06,1.51 0.01 65 1.28 0.89,1.85 0.18 344 1 0.86,1.16 0.99 306 0.97 0.82,1.13 0.67
4 1152 0.94 0.87,1.03 0.18 224 0.8 0.66,0.95 0.01 268 1.19 0.99,1.43 0.06 50 1.07 0.72,1.6 0.72 273 0.88 0.75,1.03 0.11 265 0.9 0.76,1.07 0.22
High risk group 2420 0.13 552 0.14 408 0.67 155 0.07 820 0.62 485 0.71
1 584 ref 104 ref 90 ref 39 ref 206 ref 112 ref
2 638 1.08 0.97,1.21 0.16 148 1.33 1.03,1.71 0.03 107 1.12 0.85,1.48 0.42 36 0.91 0.58,1.44 0.69 201 0.97 0.79,1.17 0.72 127 1.1 0.85,1.41 0.48
3 631 1.12 1.0,1.26 0.06 172 1.57 1.23,2.01 0.0003 115 1.2 0.91,1.58 0.2 33 0.9 0.56,1.44 0.65 221 1.11 0.92,1.34 0.29 119 1.04 0.81,1.35 0.74
4 567 1.08 0.96,1.23 0.2 128 1.28 0.98,1.67 0.07 96 1.03 0.77,1.39 0.82 47 1.37 0.88,2.13 0.17 192 1.09 0.89,1.33 0.41 127 1.2 0.92,1.55 0.17
*Adjusted by age, diabetes, and education level. Adjusted for race in pooled analysis
BMI (ethnic-specific quartiles)
Localized and Low
Gleason
Non-localized or
High Gleason
All men White African-American Native Hawaiian Japanese American Latino
6
Table 4. Relative risks of prostate cancer in relation to body mass index at age 21 by race/ethnicity in the MEC (1993-2018)
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
All Cancers 8103 1780 1680 416 2299 1928
1 2096 ref ref 0.11 454 ref 0.21 407 ref 0.77 119 ref 0.99 602 ref 0.33 485 ref 0.43
2 2115 1.05 0.99,1.12 0.11 493 1.07 0.94,1.21 0.32 433 1.08 0.94,1.23 0.28 97 0.88 0.67,1.15 0.33 624 1.03 0.92,1.15 0.67 532 1.08 0.96,1.22 0.21
3 2071 1.02 0.96,1.09 0.46 434 0.97 0.85,1.1 0.61 444 1.14 0.99,1.3 0.06 112 1.08 0.83,1.4 0.57 585 1.01 0.9,1.13 0.92 492 1.02 0.9,1.16 0.74
4 1821 0.97 0.91,1.04 0.41 399 0.95 0.83,1.08 0.41 396 1.03 0.9,1.18 0.67 88 0.93 0.71,1.24 0.63 488 0.96 0.85,1.08 0.49 419 0.95 0.84,1.09 0.48
Stage Localized 6342 1404 1289 325 1893 1431
1 1666 ref ref 0.002 371 ref 0.04 314 ref 0.39 95 ref 0.26 519 ref 0.03 350 ref 0.5
2 1674 1.05 0.98,1.12 0.19 385 1.02 0.89,1.18 0.77 348 1.12 0.96,1.3 0.15 73 0.82 0.6,1.11 0.2 511 0.98 0.86,1.1 0.7 401 1.13 0.98,1.3 0.11
3 1626 1.01 0.95,1.09 0.71 335 0.91 0.79,1.06 0.22 332 1.1 0.94,1.29 0.22 97 1.15 0.87,1.53 0.33 480 0.96 0.85,1.09 0.53 367 1.05 0.91,1.22 0.5
4 1376 0.93 0.87,1.0 0.053 313 0.9 0.78,1.05 0.19 295 0.99 0.84,1.16 0.87 60 0.79 0.57,1.1 0.16 383 0.88 0.77,1.0 0.051 313 0.98 0.84,1.15 0.82
Regional + Distant 1222 287 238 77 303 317
1 290 ref ref 0.01 63 ref 0.23 58 ref 0.59 23 ref 0.23 59 ref 0.003 81 ref 0.83
2 298 1.07 0.91,1.26 0.43 80 1.26 0.9,1.75 0.18 50 0.89 0.61,1.31 0.56 18 0.86 0.47,1.6 0.64 81 1.35 0.97,1.89 0.08 81 0.99 0.72,1.34 0.92
3 303 1.06 0.9,1.25 0.48 72 1.16 0.83,1.63 0.4 69 1.26 0.89,1.78 0.2 14 0.72 0.37,1.4 0.33 75 1.29 0.92,1.81 0.15 80 0.98 0.72,1.33 0.88
4 331 1.2 1.03,1.41 0.02 72 1.21 0.86,1.7 0.27 61 1.14 0.79,1.63 0.48 22 1.2 0.66,2.18 0.55 88 1.64 1.17,2.29 0.004 75 0.96 0.7,1.32 0.81
Grade Low Gleason 5732 1223 1247 271 1505 1486
1 1453 ref ref 0.055 323 ref 0.02 300 ref 0.85 80 ref 0.35 394 ref 0.31 356 ref 0.96
2 1512 1.08 1.01,1.16 0.04 339 1.03 0.88,1.2 0.72 325 1.1 0.94,1.29 0.24 62 0.82 0.59,1.14 0.24 399 1 0.87,1.15 0.96 415 1.15 0.99,1.32 0.06
3 1474 1.04 0.96,1.11 0.36 296 0.91 0.78,1.07 0.26 316 1.1 0.94,1.29 0.24 74 1.04 0.76,1.43 0.81 382 1 0.87,1.15 0.95 383 1.08 0.93,1.24 0.33
4 1293 0.97 0.9,1.04 0.38 265 0.86 0.73,1.01 0.07 306 1.06 0.91,1.25 0.46 55 0.84 0.6,1.2 0.34 330 0.96 0.83,1.11 0.58 332 1.01 0.87,1.18 0.87
High Gleason 1985 464 315 132 724 350
1 545 ref ref 0.9 108 ref 0.2 79 ref 0.86 36 ref 0.43 193 ref 0.9 99 ref 0.18
2 491 0.95 0.84,1.07 0.4 122 1.12 0.87,1.46 0.38 76 0.99 0.72,1.36 0.96 31 0.94 0.58,1.52 0.81 198 1.02 0.84,1.24 0.85 95 0.95 0.72,1.26 0.71
3 500 0.99 0.88,1.12 0.92 117 1.12 0.86,1.45 0.41 92 1.24 0.91,1.67 0.17 36 1.17 0.73,1.86 0.52 183 1 0.82,1.22 0.98 86 0.88 0.66,1.18 0.4
4 449 1 0.88,1.13 0.97 117 1.21 0.93,1.57 0.16 68 0.94 0.68,1.3 0.72 29 1.02 0.62,1.68 0.93 150 0.96 0.78,1.2 0.73 70 0.8 0.59,1.08 0.15
Aggressiveness Low risk group 4891 1079 1043 238 1331 1200
1 1267 ref ref 0.004 296 ref 0.01 253 ref 0.41 74 ref 0.24 353 ref 0.15 294 ref 0.59
2 1304 1.07 0.99,1.16 0.09 298 0.99 0.84,1.16 0.89 286 1.15 0.97,1.36 0.12 51 0.73 0.51,1.05 0.09 356 1 0.86,1.16 1 336 1.13 0.96,1.32 0.14
3 1238 1 0.92,1.08 0.98 251 0.85 0.72,1.0 0.06 257 1.06 0.89,1.26 0.5 66 1 0.72,1.4 0.99 336 0.98 0.84,1.14 0.78 303 1.03 0.88,1.21 0.7
4 1082 0.93 0.86,1.01 0.09 234 0.83 0.7,0.99 0.04 247 1.02 0.85,1.21 0.86 47 0.78 0.54,1.13 0.18 286 0.93 0.79,1.09 0.36 267 0.99 0.84,1.17 0.9
High risk group 2420 552 408 155 820 485
1 624 ref ref 0.26 122 ref 0.25 102 ref 0.99 41 ref 0.46 212 ref 0.61 119 ref 0.83
2 594 1 0.89,1.12 0.96 147 1.19 0.93,1.51 0.16 90 0.91 0.68,1.21 0.51 37 0.97 0.62,1.52 0.9 221 1.03 0.86,1.25 0.74 129 1.07 0.83,1.37 0.62
3 628 1.07 0.95,1.19 0.26 145 1.2 0.95,1.53 0.13 122 1.26 0.97,1.64 0.09 43 1.21 0.78,1.86 0.39 207 1.02 0.84,1.23 0.87 126 1.05 0.82,1.35 0.69
4 574 1.07 0.95,1.2 0.29 138 1.22 0.95,1.56 0.11 94 0.99 0.74,1.31 0.92 34 1.04 0.65,1.64 0.88 180 1.02 0.83,1.25 0.86 111 1 0.77,1.29 0.98
*Adjusted by age, diabetes, and education level. Adjusted for race in pooled analysis
BMI at age 21 (ethnic-specific quartiles)
Localized and Low
Gleason
Non-localized or
High Gleason
All men White African-American Native Hawaiian Japanese American Latino
7

Table 5. Relative risks of prostate cancer in relation to waist-hip ratio by race/ethnicity in the MEC (1993-2018)
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
All Cancers 1680 0.81 413 0.21 208 0.43 111 0.83 607 0.37 341 0.14
1 415 ref 114 ref 42 ref 29 ref 139 ref 82 ref
2 435 1.05 0.91,1.2 0.51 101 0.91 0.69,1.18 0.47 66 1.54 1.04,2.27 0.03 27 0.9 0.53,1.52 0.68 162 1.11 0.89,1.39 0.37 76 0.93 0.68,1.27 0.65
3 432 1.1 0.96,1.26 0.15 96 0.99 0.75,1.3 0.93 58 1.45 0.97,2.16 0.07 21 0.81 0.46,1.42 0.46 149 1.1 0.88,1.39 0.41 106 1.09 0.82,1.46 0.55
4 398 1.03 0.89,1.18 0.72 102 0.82 0.62,1.07 0.14 42 1.05 0.68,1.62 0.83 34 0.94 0.57,1.55 0.8 157 1.14 0.9,1.43 0.27 77 1.2 0.88,1.64 0.25
Stage Localized 1283 0.71 313 158 87 486 239 0.57
1 328 ref 91 ref 0.19 31 ref 0.44 28 ref 0.52 108 ref 0.42 65 ref
2 338 1.03 0.88,1.2 0.74 77 0.87 0.64,1.18 0.37 52 1.65 1.06,2.58 0.03 20 0.7 0.39,1.24 0.22 135 1.19 0.92,1.53 0.18 49 0.76 0.52,1.1 0.14
3 324 1.05 0.9,1.23 0.5 69 0.9 0.66,1.23 0.49 46 1.59 1.00,2.50 0.05 12 0.5 0.25,0.98 0.04 118 1.12 0.86,1.45 0.4 75 0.98 0.70,1.36 0.88
4 293 0.96 0.82,1.13 0.66 76 0.77 0.56,1.04 0.09 29 1.01 0.61,1.69 0.96 27 0.79 0.46,1.35 0.38 125 1.15 0.88,1.49 0.31 50 0.99 0.68,1.44 0.96
Regional + Distant 250 0.19 69 25 20 79 57 0.33
1 46 ref 11 ref 0.62 5 ref 0.79 1 ref 0.53 20 ref 0.6 9 ref
2 54 1.18 0.8,1.76 0.41 18 1.68 0.79,3.56 0.18 5 1 0.29,3.46 1 6 5.75 0.69,47.8 0.11 15 0.73 0.38,1.43 0.36 12 1.35 0.57,3.21 0.49
3 73 1.64 1.13,2.38 0.009 19 2 0.95,4.21 0.07 7 1.53 0.48,4.84 0.47 7 7.34 0.90,59.9 0.06 18 0.97 0.51,1.83 0.92 21 1.96 0.9,4.29 0.09
4 77 1.7 1.18,2.47 0.005 21 1.67 0.8,3.47 0.17 8 1.64 0.53,5.06 0.39 6 4.53 0.54,37.8 0.16 26 1.36 0.75,2.45 0.31 15 2.08 0.91,4.76 0.08
Grade Low Gleason 1210 0.66 289 0.1 156 0.76 74 0.69 426 0.26 265 0.12
1 306 ref 86 ref 32 ref 21 ref 97 ref 63 ref
2 316 1.05 0.9,1.23 0.56 73 0.89 0.65,1.22 0.47 52 1.58 1.02,2.46 0.04 17 0.78 0.41,1.48 0.44 114 1.13 0.86,1.48 0.75 62 0.99 0.7,1.41 0.96
3 292 1.03 0.88,1.21 0.73 61 0.86 0.62,1.19 0.35 40 1.32 0.83,2.11 0.24 11 0.6 0.29,1.25 0.17 101 1.09 0.82,1.44 0.56 83 1.12 0.81,1.56 0.48
4 296 1.04 0.89,1.23 0.62 69 0.73 0.53,1.01 0.06 32 1.05 0.64,1.72 0.86 25 0.97 0.54,1.75 0.93 114 1.2 0.91,1.57 0.2 57 1.17 0.82,1.68 0.39
High Gleason 394 0.87 98 0.38 39 0.34 32 0.89 163 0.71 62 0.47
1 85 ref 17 ref 8 ref 7 ref 38 ref 14 ref
2 104 1.16 0.87,1.55 0.32 25 1.41 0.76,2.62 0.27 11 1.31 0.53,3.27 0.56 9 1.28 0.47,3.43 0.63 45 1.11 0.72,1.72 0.62 11 0.79 0.36,1.73 0.55
3 116 1.41 1.06,1.86 0.02 28 1.84 1.01,3.37 0.05 11 1.4 0.56,3.48 0.47 8 1.19 0.43,3.29 0.74 42 1.11 0.72,1.72 0.64 19 1.13 0.57,2.26 0.73
4 89 1.1 0.82,1.49 0.53 28 1.49 0.81,272 0.2 9 1.16 0.45,302 0.76 8 0.86 0.31,2.39 0.78 38 0.99 0.63,1.56 0.97 18 1.62 0.8,3.26 0.18
Aggressiveness Low risk group 993 0.84 246 0.08 123 0.81 61 0.73 364 0.19 199 0.36
1 254 ref 78 ref 24 ref 20 ref 77 ref 51 ref
2 257 1.02 0.86,1.21 0.83 58 0.78 0.56,1.1 0.16 42 1.71 1.04,2.83 0.04 11 0.53 0.26,1.11 0.09 102 1.27 0.95,1.71 0.11 43 0.85 0.57,1.28 0.43
3 244 1.03 0.87,1.23 0.71 52 0.8 0.56,1.14 0.22 32 1.44 0.85,2.45 0.18 8 0.47 0.21,1.06 0.07 88 1.19 0.87,1.61 0.27 64 1.07 0.74,1.55 0.71
4 238 1.01 0.85,1.21 0.88 58 0.68 0.48,0.96 0.03 25 1.13 0.64,1.98 0.68 22 0.91 0.5,1.68 0.76 97 1.26 0.93,1.71 0.13 41 1.05 0.69,1.58 0.83
High risk group 487 0.69 120 0.35 50 0.61 42 0.88 190 0.85 85 0.46
1 101 ref 18 ref 10 ref 8 ref 47 ref 18 ref
2 124 1.19 0.92,1.55 0.19 34 1.88 1.06,3.33 0.03 12 1.18 0.51,2.73 0.7 14 1.7 0.71,4.06 0.23 47 0.95 0.63,1.42 0.81 15 0.84 0.42,1.66 0.61
3 140 1.44 1.11,1.86 0.006 33 2.11 1.19,3.74 0.01 17 1.78 0.81,3.89 0.15 10 1.33 0.52,3.37 0.55 45 0.98 0.65,1.47 0.91 30 1.39 0.77,2.49 0.28
4 122 1.26 0.97,1.65 0.09 35 1.76 0.99,3.12 0.053 11 1.15 0.48,2.71 0.76 10 0.95 0.38,2.43 0.92 51 1.07 0.72,1.6 0.72 22 1.52 0.81,2.84 0.19
*Adjusted by age, diabetes, and education level. Adjusted for race in pooled analysis
Localized and Low
Gleason
Non-localized or
High Gleason
WHR (ethnic-specific quartiles)
All men White African-American Native Hawaiian Japanese American Latino
8
Table 6. Relative risks of prostate cancer in relation to height by race/ethnicity in the MEC (1993-2018)
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
All Cancers 8103 0.92 1780 0.25 1680 0.69 416 0.53 2299 0.85 1928 0.48
1 1535 ref 549 ref 495 ref 117 ref 610 ref 401 ref
2 1947 1.01 0.94,1.08 0.89 503 0.97 0.86,1.1 0.66 431 1.01 0.89,1.15 0.9 58 1.13 0.82,1.55 0.45 812 1.02 0.92,1.13 0.72 584 1.07 0.94,1.21 0.3
3 2666 1.04 0.97,1.12 0.23 233 1 0.86,1.16 0.97 267 1.06 0.91,1.23 0.45 128 1.26 0.98,1.63 0.07 314 0.84 0.74,0.97 0.02 480 1.04 0.91,1.19 0.6
4 1955 1.02 0.94,1.11 0.6 495 0.92 0.82,1.04 0.2 487 1.01 0.89,1.15 0.83 113 1.03 0.79,1.33 0.84 563 1.02 0.9,1.14 0.79 463 1.06 0.93,1.22 0.4
Stage Localized 6342 0.8 1404 0.23 1289 0.28 325 0.56 1893 0.32 1431 0.87
1 1237 ref 435 ref 365 ref 91 ref 517 ref 300 ref
2 1545 1 0.93,1.08 0.97 395 0.96 0.84,1.1 0.55 321 1.02 0.87,1.18 0.84 46 1.15 0.81,1.64 0.44 678 1 0.9,1.13 0.95 441 1.07 0.93,1.24 0.35
3 2029 1 0.93,1.08 0.93 182 0.98 0.82,1.17 0.81 213 1.13 0.95,1.34 0.16 95 1.21 0.91,1.61 0.2 249 0.79 0.68,0.92 0.002 353 1.01 0.87,1.18 0.87
4 1531 1.01 0.92,1.1 0.9 392 0.91 0.8,1.05 0.2 390 1.08 0.94,1.25 0.29 93 1.08 0.81,1.44 0.61 449 0.96 0.84,1.09 0.52 337 1.02 0.87,1.19 0.83
Regional + Distant 1222 0.09 287 0.69 238 0.62 77 0.59 303 0.23 317 0.04
1 192 ref 84 ref 80 ref 22 ref 70 ref 53 ref
2 282 1.12 0.93,1.35 0.24 81 1.06 0.78,1.44 0.73 61 0.89 0.63,1.24 0.47 9 0.94 0.43,2.04 0.87 99 1.05 0.77,1.43 0.76 92 1.26 0.9,1.77 0.18
3 439 1.31 1.09,1.57 0.004 40 1.15 0.79,1.68 0.48 35 0.87 0.59,1.3 0.5 29 1.57 0.9,2.74 0.11 45 0.99 0.68,1.44 0.94 84 1.36 0.97,1.93 0.08
4 309 1.24 1.01,1.53 0.04 82 1.03 0.75,1.4 0.86 62 0.8 0.57,1.11 0.18 17 0.85 0.45,1.6 0.6 89 1.29 0.93,1.77 0.12 88 1.49 1.05,2.1 0.02
Grade Low Gleason 5732 0.45 1223 0.01 1247 0.43 271 0.49 1505 0.86 1486 0.93
1 1075 ref 393 ref 358 ref 78 ref 399 ref 325 ref
2 1372 0.98 0.9,1.06 0.64 337 0.9 0.78,1.05 0.18 317 1.02 0.88,1.19 0.8 41 1.19 0.82,1.74 0.37 520 0.98 0.86,1.11 0.72 443 1 0.87,1.16 0.98
3 1877 1 0.92,1.08 0.91 161 0.95 0.79,1.14 0.6 210 1.13 0.96,1.35 0.15 74 1.1 0.8,1.51 0.56 213 0.84 0.71,0.99 0.04 362 0.97 0.83,1.13 0.67
4 1408 0.98 0.89,1.07 0.64 332 0.84 0.73,0.98 0.03 362 1.02 0.88,1.18 0.78 78 1.05 0.76,1.44 0.78 373 0.98 0.85,1.13 0.77 356 1 0.86,1.17 0.98
High Gleason 1985 0.11 464 0.09 315 0.84 132 0.73 724 0.97 350 0.14
1 398 ref 128 ref 94 ref 34 ref 188 ref 60 ref
2 487 1.06 0.93,1.21 0.39 142 1.19 0.94,1.52 0.15 85 1.05 0.79,1.41 0.72 14 0.94 0.5,1.75 0.84 269 1.13 0.94,1.37 0.19 115 1.4 1.03,1.92 0.03
3 658 1.19 1.04,1.37 0.01 55 1.03 0.75,1.41 0.86 46 0.98 0.69,1.4 0.92 51 1.76 0.14,2.72 0.01 96 0.88 0.68,1.12 0.29 88 1.26 0.91,1.75 0.17
4 442 1.14 0.97,1.34 0.1 139 1.14 0.9,1.46 0.28 90 1.01 0.75,1.35 0.95 33 1.05 0.65,1.7 0.84 171 1.08 0.88,1.34 0.46 87 1.32 0.95,1.84 0.1
Aggressiveness Low risk group 4891 0.59 1079 0.03 1043 0.18 238 0.56 1331 0.5 1200 1
1 924 ref 350 ref 290 ref 70 ref 361 ref 260 ref
2 1173 0.98 0.9,1.07 0.68 295 0.89 0.76,1.04 0.14 261 1.04 0.88,1.22 0.69 34 1.11 0.73,1.67 0.63 462 0.96 0.84,1.1 0.55 357 1.01 0.86,1.18 0.95
3 1583 0.99 0.9,1.08 0.75 140 0.93 0.77,1.14 0.49 177 1.18 0.98,1.42 0.09 64 1.06 0.76,1.49 0.73 182 0.8 0.66,0.95 0.01 300 1 0.84,1.18 0.97
4 1211 0.99 0.89,1.09 0.77 294 0.84 0.72,0.99 0.03 315 1.09 0.93,1.28 0.29 70 1.05 0.75,1.46 0.78 326 0.95 0.81,1.1 0.48 283 0.99 0.83,1.17 0.88
High risk group 2420 0.2 552 0.34 408 0.64 155 0.77 820 0.8 485 0.13
1 469 ref 152 ref 127 ref 41 ref 211 ref 86 ref
2 594 1.06 0.94,1.2 0.36 167 1.17 0.94,1.46 0.17 106 0.97 0.75,1.26 0.82 19 1.05 0.61,1.82 0.85 298 1.1 0.92,1.31 0.3 156 1.31 1.01,1.71 0.04
3 802 1.16 1.02,1.32 0.02 70 1.09 0.82,1.44 0.58 64 1 0.74,1.35 0.98 57 1.61 1.08,2.41 0.02 110 0.87 0.69,1.09 0.23 115 1.14 0.86,1.51 0.36
4 555 1.12 0.97,1.29 0.13 163 1.1 0.88,1.38 0.4 111 0.89 0.69,1.16 0.39 38 0.99 0.63,1.54 0.95 201 1.09 0.89,1.32 0.41 128 1.32 1.0,1.74 0.051
*Adjusted by age, diabetes, and education level. Adjusted for race in pooled analysis
Height (ethnic-specific quartiles)
Localized and
Low Gleason
Non-localized or
High Gleason
All men White African-American Native Hawaiian Japanese American Latino
9
4. Discussion
In summary, we found strong evidence to suggest that BMI to be positively associated with risk of
advanced, high grade, and aggressive prostate cancer in EA. In contrast, high BMI was found to be
inversely associated with risk of low grade and nonaggressive prostate cancer in EA. BMI at age 21 is
positively associated with non-localized prostate cancer in pooled analyses (driven by JA), and protective
in localized (driven by EA and JA), low-grade (driven by EA), and non-aggressive prostate cancer in all
men (driven by EA). WHR was found to be associated with advanced and aggressive prostate cancer,
although we did not detect a strong linear trend. Still, we observed high WHR to be inversely associated
with nonaggressive prostate cancer in EA men, but positively associated with risk within AA men. Finally,
tallness was positively related to advanced, high grade, and aggressive disease in all men. In EA, there
was found to be an inverse association observed with increasing height, and low Gleason grade and
nonaggressive prostate cancer.
BMI in middle and late adulthood appears to be differentially related to risk of prostate cancer across
disease subtypes. Notably, Barrington, et al. also found a protective association between BMI and low-
grade cancer in non-Hispanic white men, and a positive association in African Americans [6]. They found
a positive association in both non-Hispanic white men and African American men, with the risk higher in
African American men. Our findings with low-grade/non-aggressive cancer are in concordance with
Barrington, et al. but we found a largely positive association in EA in relation to BMI and advanced/high-
grade/aggressive prostate cancer.
Our analysis of BMI at 21 showed an overall decrease in risk in localized and non-aggressive prostate
cancer, and an overall increase in risk in advanced prostate cancer. Other studies show inconsistent
evidence of an association between obesity in early adulthood and prostate cancer. Moreover, findings
for non-advanced or non-aggressive prostate cancer are mixed. For example, Moller, et al [17] found an
inverse association between increase in BMI at 21 and total and advanced prostate cancer.
While we found a weak association between high WHR and prostate cancer, our findings are in line with
studies that have predominantly white populations. For instance, Pichardo, et al. also found a positive
association with increased WHR and increased risk of prostate cancer, especially aggressive cancer
[5,19]. One study however, did not find any association among AA men [5], while we found a positive
association with increasing WHR and localized prostate cancer in AA men.
While we did not find a statistically linear association between tallness and advanced prostate cancer,
our findings on height are in line with other studies, which find that tallness is positively associated with
advanced/aggressive/fatal prostate cancer [17,22]. Other studies have found tallness to be protective
against non-advanced prostate cancer in AA [8]. This is in contrast to the null finding we have for AAs in
our study. Additionally, we found that tallness is inversely associated with low-grade and nonaggressive
prostate cancer in EA.
Our study has several strengths. First, we have a large, prospective study, and long follow-up time.
Additionally, our study includes detailed information on tumor stage and grade, enabled detailed
analyses of prostate cancer subtypes. Moreover, we are able to take into account ethnic-specific body
measurements. Limitations of the study include only having a one-time measure of BMI. However, from
doing a sensitivity analyses looking at stratifying the association by age group at baseline (50s, 60s, 70s),
there was a decrease in relative risk, although very slight.
10
In summary, our updated extensive analysis in the MEC explored the association between
anthropometric measurements and prostate cancer using ethnic-specific quartiles. We further
demonstrated risk of prostate cancer by tumor subtypes. However, more observational and
experimental studies using repeated measures of anthropometric measurements are needed in order to
draw conclusions on causality regarding the complex role of body size in prostate cancer development.

5. References
1. Centers for Disease Control and Prevention (2018) Adult Obesity Facts. Centers for Disease Control
and Prevention, Atlanta. Available at https://www.cdc.gov/obesity/data/adult.html.
2. Waters KM, Henderson BE, Stram DO, Wan P, Kolonel LN, Haiman CA. 2009. Association of diabetes
with prostate cancer risk in the multiethnic cohort. Am J Epidemiol. 169(8):937-45.
3. Wen CP, David Cheng TY, Tsai SP, et al. 2009. Are Asians at greater mortality risks for being
overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 12:497-506.
4. Pan WH, Flegal KM, Chang HY, Yeh WT, Yeh CJ, Lee WC. 2004. Body mass index and obesity-related
metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight
and obesity for Asians. Am J Clin Nutr. 79:31-9.
5. Pichardo MS, Smith CJ, Dorsey TH, Loffredo CA, Ambs S. 2018. Association of Anthropometric
Measures with Prostate Cancer among African American Men in the NCI-Maryland Prostate Cancer
Case-Control Study. Cancer Epidemiol Biomarkers Prev. 27(8):936-944
6. Barrington WE, Schenk JM, Etzioni R, Arnold KB, Neuhouser ML, et al. 2015. Difference in Association
of Obesity With Prostate Cancer Risk Between US African American and Non-Hispanic White Men in the
Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA Oncol. 1(3):342-9.
7. Su LJ, Arab L, Steck SE, Fontham ET, Schroeder JC, Bensen JT, Mohler JL. 2011. Obesity and prostate
cancer aggressiveness among African and Caucasian Americans in a population-based study. Cancer
Epidemiol Biomarkers Prev. 20(5):844-53.
8. Layne TM, Graubard BI, Ma X, Mayne ST, Albanes D. 2019. Prostate cancer risk factors in black and
white men in the NIH-AARP Diet and Health Study. Prostate Cancer Prostatic Dis. 22(1):91-100.
9. Kolonel LN, Henderson BE, Hankin JH, Nomura AM, Wilkens LR, Pike MC, Stram DO, Monroe KR, Earle
ME, Nagamine FS. 2000. A multiethnic cohort in Hawaii and Los Angeles: baseline characteristics. Am J
Epidemiol 151(4):346–357
10. Setiawan VW, Virnig BA, Porcel J, Henderson BE, Le ML, Wilkens LR et al. 2015. Linking data from the
Multiethnic Cohort Study to Medicare data: linkage results and application to chronic disease
research. Am J Epidemiol. 181:917-9.

11
11. Chen CB, Eurich DT, Majumdar SR, Johnson JA. 2018. Risk of prostate cancer across different
racial/ethnic groups in men with diabetes: a retrospective cohort study. Diabet Med. 35(1):107-111.
12. Dickerman BA, Torfadottir JE, Valdimarsdottir UA, Wilson KM, Steingrimsdottir L, Aspelund T, Batista
JL, Fall K, Giovannucci E, Sigurdardottir LG, Tryggvadottir L, Gudnason V, Markt SC, Mucci LA. 2018.
Midlife metabolic factors and prostate cancer risk in later life. Int J Cancer. 142(6):1166-1173.
13. Choi JB, Moon HW, Park YH, Bae WJ, Cho HJ, Hong SH, Lee JY, Kim SW, Han KD, Ha US. 2016. The
Impact of Diabetes on the Risk of Prostate Cancer Development according to Body Mass Index: A 10-
year Nationwide Cohort Study. J Cancer. 7(14):2061-2066
14. Discacciati A, Orsini N, Wolk A. 2012. Body mass index and incidence of localized and advanced
prostate cancer – a dose-response meta-analysis of prospective studies. Ann Oncol. 23:1665–71.
15. MacInnis RJ, English DR. 2006. Body size and composition and prostate cancer risk: systematic
review and meta-regression analysis. Cancer Causes Control. 17:989–1003.
16. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. 2008. Body-mass index and incidence of
cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 371:569–78.
17. Möller E, Wilson KM, Batista JL, Mucci LA, Bälter K, Giovannucci E. 2016. Body size across the life
course and prostate cancer in the Health Professionals Follow-up Study. Int J Cancer. 138(4):853-65.
18. Dickerman BA, Ahearn TU, Giovannucci E, Stampfer MJ, Nguyen PL, Mucci LA, Wilson KM. 2017.
Weight change, obesity and risk of prostate cancer progression among men with clinically localized
prostate cancer. Int J Cancer. 141(5):933-944.
19. Lavalette C, Trétarre B, Rebillard X, Lamy PJ, Cénée S, Menegaux F. 2018. Abdominal obesity and
prostate cancer risk: epidemiological evidence from the EPICAP study. Oncotarget. 9(77):34485-34494
20. Lee KR, Seo MH, Do Han K, Jung J, Hwang IC; Taskforce Team of the Obesity Fact Sheet of the Korean
Society for the Study of Obesity. 2018. Waist circumference and risk of 23 site-specific cancers: a
population-based cohort study of Korean adults. Br J Cancer. 119(8):1018-1027.
21. Stevens VL, Jacobs EJ, Maliniak ML, Patel AV, Gapstur SM. 2017. No Association of Waist
Circumference and Prostate Cancer in the Cancer Prevention Study II Nutrition Cohort. Cancer Epidemiol
Biomarkers Prev. 26(12):1812-1814.
22. Perez-Cornago A, Appleby PN, Pischon T, Tsilidis KK, Tjønneland A, Olsen A, Overvad K, Kaaks R, Kühn
T, Boeing H, Steffen A, Trichopoulou A, Lagiou P, et al. 2017. Tall height and obesity are associated with
an increased risk of aggressive prostate cancer: results from the EPIC cohort study. BMC Med. 15(1):115.
23. Zuccolo L, Harris R, Gunnell D, Oliver S, Lane JA, Davis M, Donovan J, Neal D, Hamdy F, Beynon R,
Savovic J, Martin RM. 2008. Height and prostate cancer risk: a large nested case-control study (ProtecT)
and meta-analysis. Cancer Epidemiol Biomarkers Prev. 17:2325–36.

12
6. Supplementary Tables

BMI
All
European
American
African
American Hawaiian
Japanese
American Latino
25th 23.9 23.8 24.4 25.6 23 25
50th 25.9 25.9 26.7 28.3 25 27
75th 28.8 28.6 29.6 31.8 27 29.5
BMI21
All
European
American
African
American Hawaiian
Japanese
American Latino
25th 20.6 21 20.9 21.5 20.4 20.5
50th 22.3 22.5 22.6 23.5 21.7 22.2
75th 24.3 24.4 24.4 25.9 23.5 24.3
WHR
All
European
American
African
American Hawaiian
Japanese
American Latino
25th 0.91 0.92 0.89 0.92 0.91 0.92
50th 0.95 0.95 0.93 0.95 0.94 0.95
75th 1 1 0.98 1 0.97 1
Height
All
European
American
African
American Hawaiian
Japanese
American Latino
25th 66 68 68 67 65 66
50th 68 70 70 69 68 67
75th 70 72 72 71 68 69
For BMI, BMI21, and height, the total is 79,436; for WHR, the total number is 34,055.
S1. Quartile distribution for body measurements by race (n=79,436*)
13

S2. Sensitivity analysis. Relative risks of prostate cancer in relation to body mass index by race/ethnicity in the MEC (1993-2018), excluding the first 5 years of follow-up
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
No. of
cases
Relative
Risk 95% CI p-value p-trend
All Cancers 5974 0.95 1302 0.03 1115 0.19 327 0.26 1813 0.34 1417 0.49
1 1447 ref 328 ref 228 ref 83 ref 442 ref 352 ref
2 1597 1.06 0.99,1.14 0.1 354 1 0.86,1.17 0.97 307 1.22 1.03,1.45 0.02 81 0.96 0.71,1.31 0.8 477 1.06 0.93,1.21 0.35 375 1.03 0.89,1.19 0.7
3 1544 1.05 0.97,1.13 0.21 347 1 0.86,1.16 0.95 309 1.27 1.07,1.5 0.007 80 1.03 0.76,1.41 0.84 481 1.12 0.98,1.27 0.09 364 1.03 0.89,1.2 0.67
4 1386 1 0.93,1.08 0.95 273 0.84 0.71,0.99 0.04 271 1.12 0.94,1.34 0.22 83 1.18 0.86,1.63 0.3 413 1.09 0.95,1.25 0.22 326 1.01 0.86,1.17 0.93
Stage Localized 4651 0.77 1018 0.03 846 0.23 256 0.51 1494 0.84 1037 0.79
1 1123 ref 257 ref 167 ref 63 ref 368 ref 246 ref
2 1274 1.1 1.02,1.19 0.02 276 1 0.84,1.19 1 240 1.3 1.07,1.58 0.009 67 1.04 0.74,1.47 0.82 405 1.08 0.94,1.24 0.29 284 1.11 0.94,1.32 0.22
3 1208 1.07 0.99,1.17 0.09 276 1.01 0.85,1.2 0.92 235 1.31 1.07,1.6 0.008 65 1.1 0.77,1.56 0.6 402 1.12 0.97,1.29 0.13 266 1.08 0.91,1.28 0.4
4 1046 1 0.91,1.09 0.95 209 0.82 0.68,0.99 0.04 204 1.14 0.92,1.4 0.23 61 1.15 0.8,1.66 0.45 319 1 0.86,1.17 0.98 241 1.06 0.89,1.27 0.51
Regional + Distant 913 0.11 214 0.76 173 0.77 59 0.35 233 0.02 234 0.88
1 211 ref 42 ref 39 ref 18 ref 49 ref 61 ref
2 220 0.98 0.81,1.18 0.82 65 1.42 0.96,2.09 0.08 46 1.09 0.71,1.67 0.7 10 0.54 0.25,1.18 0.12 51 1.03 0.69,1.52 0.9 50 0.79 0.54,1.15 0.21
3 232 1.02 0.84,1.23 0.85 54 1.18 0.79,1.77 0.42 44 1.09 0.71,1.68 0.71 14 0.82 0.4,1.68 0.59 57 1.17 0.8,1.72 0.41 65 1.04 0.74,1.48 0.81
4 250 1.12 0.93,1.36 0.24 53 1.21 0.8,1.83 0.38 44 1.1 0.71,1.71 0.66 17 1.05 0.52,2.12 0.89 76 1.72 0.19,2.49 0.004 58 0.99 0.68,1.42 0.94
Grade Low Gleason 4236 0.27 890 0.0008 829 0.14 212 0.79 1185 0.81 1120 0.44
1 1007 ref 236 ref 166 ref 56 ref 288 ref 276 ref
2 1141 1.07 0.98,1.16 0.14 251 0.99 0.83,1.18 0.88 233 1.27 1.04,1.55 0.02 56 0.98 0.68,1.43 0.93 323 1.09 0.93,1.28 0.3 302 1.05 0.89,1.24 0.57
3 1081 1.01 0.92,1.1 0.9 221 0.87 0.73,1.05 0.15 214 1.2 0.98,1.47 0.08 56 1.06 0.73,1.55 0.75 308 1.07 0.91,1.26 0.39 289 1.03 0.87,1.22 0.72
4 1007 0.97 0.89,1.07 0.58 182 0.75 0.62,0.92 0.005 216 1.19 0.97,1.47 0.09 44 0.93 0.62,1.4 0.73 266 1.03 0.86,1.22 0.78 253 0.97 0.82,1.16 0.75
High Gleason 1445 0.01 342 0.17 198 0.66 106 0.01 571 0.18 228 0.95
1 358 ref 69 ref 41 ref 24 ref 137 ref 57 ref
2 389 1.12 0.97,1.29 0.13 86 1.16 0.85,1.59 0.36 50 1.11 0.74,1.68 0.61 23 0.93 0.52,1.65 0.8 143 1.06 0.84,1.34 0.64 59 1.03 0.71,1.48 0.89
3 382 1.21 1.04,1.4 0.01 111 1.53 0.13,2.07 0.006 68 1.6 1.08,2.36 0.02 22 0.96 0.54,1.74 0.9 156 1.22 0.97,1.54 0.09 51 0.94 0.65,1.38 0.76
4 316 1.14 0.97,1.34 0.12 76 1.17 0.84,1.64 0.35 39 0.93 0.6,1.45 0.75 37 1.75,1.02 3.01 0.04 135 1.24 0.97,1.59 0.08 61 1.28 0.88,1.85 0.19
Aggressiveness Low risk group 3597 0.27 787 0.003 689 0.2 185 0.76 1052 0.86 884 0.66
1 861 ref 208 ref 135 ref 48 ref 259 ref 213 ref
2 973 1.08 0.98,1.18 0.13 220 0.98 0.81,1.19 0.85 197 1.32 1.06,1.64 0.01 49 1.01 0.67,1.5 0.98 293 1.09 0.93,1.29 0.29 242 1.09 0.91,1.31 0.35
3 927 1.03 0.94,1.13 0.56 195 0.88 0.72,1.07 0.18 183 1.26 1.01,1.57 0.04 50 1.11 0.74,1.66 0.62 275 1.06 0.89,1.26 0.5 230 1.07 0.89,1.29 0.5
4 836 0.97 0.88,1.07 0.57 164 0.77 0.62,0.95 0.02 174 1.18 0.94,1.48 0.16 38 0.95 0.61,1.47 0.8 225 0.96 0.8,1.15 0.64 199 1 0.82,1.22 0.99
High risk group 1774 0.01 400 0.19 272 0.7 124 0.04 636 0.07 342 0.91
1 422 ref 78 ref 57 ref 31 ref 149 ref 83 ref
2 477 1.13 0.99,1.29 0.07 108 1.29 0.96,1.72 0.09 74 1.19 0.84,1.68 0.33 27 0.85 0.5,1.42 0.53 154 1.04 0.83,1.3 0.74 84 0.98 0.73,1.33 0.91
3 453 1.14 1.0,1.31 0.06 124 1.5 1.13,1.99 0.005 78 1.31 0.93,1.84 0.13 27 0.91 0.54,1.54 0.73 171 1.21 0.97,1.51 0.09 80 0.97 0.71,1.32 0.85
4 422 1.16 1.0,1.34 0.04 90 1.19 0.87,1.63 0.27 63 1.06 0.74,1.53 0.74 39 1.41 0.86,2.32 0.17 162 1.32 1.05,1.65 0.02 95 1.24 0.92,1.68 0.15
*Adjusted by age, diabetes, and education level. Adjusted for race in pooled analysis
BMI (ethnic-specific quartiles)
All men
Localized and Low
Gleason
Non-localized or
High Gleason
White African-American Native Hawaiian Japanese American Latino
14

Abstract (if available)

Abstract Obesity is increasingly common and widespread in the Western world, with a prevalence of 39.8% in US adults in 2015-2016. Currently, the evidence regarding the association between anthropometric measures quantifying obesity and prostate cancer risk has been conflicting. Moreover, little research has been done to explore this association in other ethnic groups. Here, we conduct a pooled analysis using data of 79,436 men from the Multiethnic cohort, and accounting for ethnic differences in body composition, investigate the relation between body mass index (BMI) and BMI at age 21, waist-hip-ratio (WHR), and height, with risk of prostate cancer. Total prostate cancer, as well as risk stratified by stage, grade, and aggressiveness of disease, were studied. We estimated the relative risk of prostate cancer using Cox proportional hazards model. With 15 years of follow-up (1993-2018), we identifying 8,333 incident cases of prostate cancer. High BMI was associated with advanced and aggressive tumors, and this was more evident in the sensitivity analyses (RR for high grade cancer 1.14, 95% CI: 0.97,1.34, highest vs lowest quartile, p-trend=0.01

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Creator Sattayapiwat, Olivia (author)

Core Title Body size and the risk of prostate cancer in the multiethnic cohort

School Keck School of Medicine

Degree Master of Science

Degree Program Applied Biostatistics and Epidemiology

Publication Date 05/08/2019

Defense Date 05/08/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag body mass index,body size,Epidemiology,height,OAI-PMH Harvest,prostatic neoplasms,waist-hip-ratio

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Advisor Haiman, Christopher (committee chair), McKean-Cowdin, Roberta (committee member), Setiawan, Veronica Wendy (committee member)

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