The influence of physical activity on prostate cancer diagnosis: a biopsy
cohort analysis
Andrea Tubaro, Luca Cindolo1, Toutziaris C3, Kampantais S3, Sountoulides P3, Giovis G3, Mauro
Gacci2, Fabrizio Pellegrini1, Luigi Schips1, Riccardo Lombardo, Fabiana Cancrini, Fabrizio
Presicce, Ludy Mendes, Giovanni Giordano, Silvia Massimiani, Cosimo De Nunzio
Department of Urology, Ospedale Sant’Andrea, University “La Sapienza”, Roma, Italy
1
2
3
UOC Urologia, Ospedale Padre Pio da Pietrelcina, Vasto, Italy
Dipartimento di Urologia, Ospedale Careggi, Università di Firenze
Department of Urology, Genimatas and Veria Hospitals, Thessaloniki, Greece
Purpose: A possible relationship between prostate cancer and physical activity has been proposed.
The Physical activity scale for elderly (PASE) questionnaire has been recently proposed to evaluate
the association between physical activity and benign prostatic hyperplasia. Aim of our study was to
evaluate the association between physical activity and prostate cancer (PCa) risk and grade in a
consecutive series of men undergoing prostate biopsy
Materials and methods: From 2011 onwards, a consecutive men undergoing 12-core prostate
biopsy were enrolled into a prospective database. Indications for a prostatic biopsy were a PSA
value ≥ 4 ng/ml and/or a positive digital rectal examination (DRE). Body mass index (BMI) and
waist circumferences were measured before the biopsy. Blood samples were collected before biopsy
and tested for: total PSA, glycemia, HDL, trygliceridemia levels. Blood pressure was recorded.
Metabolic syndrome (MetS) was defined according to the Adult Treatment panel III. PASE
questionnaire was colelcted before the biopsy.
Results: 296 patients were enrolled with a median age and PSA of 67 (IQR 61/73) years and 6.9
ng/ml (IQR 5/9.6) respectively. Median BMI was 26.5 kg/m2 (IQR: 24.7/28.7); median waist
circumference was 100 cm (IQR: 100/108) and 60 pts (20%) presented a Metabolic syndrome.
One-hundred and eight patients (36.5%) had prostate cancer on biopsy. Patients with PCa presented
an higher PSA (7.6 ng/ml, IQR: 5.3/14 vs 6.5 ng/ml, IQR4.8/8; p= 0.001) and a lower PASE score
(103, IQR: 68/165 vs 131, IQR 93/201; p=0.001). No association between PCa and MetS was
observed (p= 0.337). PASE score inversely correlate with waist circumference (σ: -0.179; p=
0.0172) and Age (σ-0.213; p= 0.001). On multivariate analysis PASE (OR: 0.996 per unit, 95%CI:
0.992-0.999; p= 0.003)) and PSA (1.073 per unit 95%CI: 1.023-1.123, p= 0.04) were the only
independent risk factor for prostate cancer diagnosis.
Discussion: Even though the molecular pathways are yet to be understood, it is assumable that a
reduced physical activity and the associated metabolic abnormalities should be considered as
possible factors involved in prostate cancer pathogenesis. However these results should be
confirmed in a larger multicenter study.
Conlusions :In our single center study, a reduced physical activity evaluated by the PASE
questionnaire is associated with an increased risk of prostate cancer on biopsy.