Subcutaneous adipose tissue characteristics and the risk of biochemical recurrence in men with high-risk prostate cancer

Andrew M. McDonald, John B. Fiveash, Robert S. Kirkland, Rex A. Cardan, Rojymon Jacob, Robert Y. Kim, Michael C. Dobelbower, Eddy S. Yang

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Purpose/objective(s) To assess subcutaneous adipose tissue characteristics by computed tomography (CT) as potential imaging biomarkers predictive of biochemical recurrence in men with high-risk prostate cancer receiving radiotherapy (RT). Materials and methods This retrospective study included men with high-risk prostate cancer (PSA>20 ng/ml, Gleason score ≥8, or clinical extraprostatic extension) treated between 2001 and 2012. All patients received definitive, dose-escalated external beam RT along with a course of neoadjuvant, concurrent, and adjuvant androgen deprivation therapy (ADT). Each patient also had a treatment planning CT that included the L4-L5 vertebral interface and prostate specific antigen (PSA) measurements for at least 2 years following RT. The subcutaneous adipose tissue was contoured on a single axial CT slice at the level of L4-L5. The average CT attenuation, in Hounsfield units (HU), of the structure was calculated and defined as SATHU. SATAREA was defined as the cross-sectional area of the structure (in cm2) that was then normalized by the square of patient height. Biochemical failure (BF) was defined as a PSA rise of 2 ng/ml from the nadir. Freedom from BF (FFBF) was calculated from start time of ADT using the Kaplan-Meier method. Estimates of FFBF were stratified by SATHU and SATAREA quartiles. Results A total of 171 men met the inclusion criteria with a median follow-up of 5.6 years. The mean SATHU (±standard deviation) was −99.2 HU (±6.1 HU), and the mean SATAREA was 93.2 cm2/m2 (±39.4 cm2/m2). The 5- and 8-year rates of FFBF across all patients were 81.5% and 73.5%, respectively. Patients in the lowest quartile of SATHU experienced significantly higher FFBF compared to the other quartiles (Q4 vs. Q1, P = 0.017; Q4 vs. Q2, P = 0.045; Q4 vs. Q3, P = 0.044). No other differences in FFBF were observed between quartiles of SATAREA or other quartiles of SATHU. Conclusion Lower subcutaneous adipose tissue density was associated with a lower rate of BF following RT with ADT for men with high-risk prostate cancer. Further research is needed to elucidate the biological underpinnings of this clinical finding and the role adipose tissue plays in modulating oncologic behavior and outcomes.

Original languageEnglish
Pages (from-to)663.e15-663.e21
JournalUrologic Oncology: Seminars and Original Investigations
Issue number11
StatePublished - Nov 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.


  • Adipose tissue density
  • Body composition
  • Computed tomography
  • Imaging biomarker
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Urology


Dive into the research topics of 'Subcutaneous adipose tissue characteristics and the risk of biochemical recurrence in men with high-risk prostate cancer'. Together they form a unique fingerprint.

Cite this