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Weight trajectories throughout adulthood and prostate cancer incidence, aggressiveness, and death in 258 494 men

da Silva, Marisa LU orcid ; Fritz, Josef LU orcid ; Elhakeem, Ahmed ; Jochems, Sylvia H J LU ; Sun, Ming LU ; Mboya, Innocent B LU orcid ; Häggström, Christel LU ; Wahlström, Jens ; Michaëlsson, Karl and Magnusson, Patrik K E , et al. (2026) In Journal of the National Cancer Institute 118(6). p.1006-1014
Abstract

BACKGROUND: Obesity assessed at a single time point in adulthood has shown no consistent association with prostate cancer (PCa) incidence but has been positively associated with PCa death. We investigated the association of total and age-specific adult weight trajectories with PCa aggressiveness and death.

METHODS: We analyzed data from 258,494 men in Sweden with at least 3 weight observations between ages 17 and 60. Individual weight trajectories were estimated using linear mixed-effects models with natural cubic and linear splines for age, incorporating random intercepts and slopes. These estimates were included in multivariable-adjusted Cox proportional hazards models.

RESULTS: Over a median follow-up of 25 years, 22 055... (More)

BACKGROUND: Obesity assessed at a single time point in adulthood has shown no consistent association with prostate cancer (PCa) incidence but has been positively associated with PCa death. We investigated the association of total and age-specific adult weight trajectories with PCa aggressiveness and death.

METHODS: We analyzed data from 258,494 men in Sweden with at least 3 weight observations between ages 17 and 60. Individual weight trajectories were estimated using linear mixed-effects models with natural cubic and linear splines for age, incorporating random intercepts and slopes. These estimates were included in multivariable-adjusted Cox proportional hazards models.

RESULTS: Over a median follow-up of 25 years, 22 055 men were diagnosed with PCa and 4547 died from the disease. Steep weight gain was inversely associated with PCa diagnosed during the PSA testing era (1997 onwards) and via asymptomatic PSA testing, but not with aggressive PCa. Among men with PCa, steep weight gain was associated with increased risk of PCa death (HR quintile 5 vs. 1 = 1.23, 95% CI = 1.08 to 1.40), primarily driven by weight gain between ages 45 and 60 (HR per 1 kg/year = 1.31, 95% CI = 1.10 to 1.57).

CONCLUSIONS: The associations observed for incident PCa appear to be influenced by PSA testing uptake; however, the extent to which detection bias contributes remains uncertain. Conversely, late midlife weight gain was associated with an elevated risk of PCa death, underscoring the importance of weight management during this period as a potentially modifiable factor for reducing PCa death.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Male, Prostatic Neoplasms/epidemiology, Middle Aged, Sweden/epidemiology, Incidence, Adult, Weight Gain, Obesity/complications, Risk Factors, Adolescent, Body-Weight Trajectory, Prostate-Specific Antigen/blood, Young Adult, Proportional Hazards Models, Follow-Up Studies, Body Mass Index
in
Journal of the National Cancer Institute
volume
118
issue
6
pages
1006 - 1014
publisher
Oxford University Press
external identifiers
  • scopus:105041257053
  • pmid:41587945
ISSN
1460-2105
DOI
10.1093/jnci/djag014
language
English
LU publication?
yes
additional info
© The Author(s) 2026. Published by Oxford University Press.
id
f55b50f3-be99-4eb0-ab65-5afc503c0f15
date added to LUP
2026-08-26 11:10:53
date last changed
2026-08-27 04:00:53
@article{f55b50f3-be99-4eb0-ab65-5afc503c0f15,
  abstract     = {{<p>BACKGROUND: Obesity assessed at a single time point in adulthood has shown no consistent association with prostate cancer (PCa) incidence but has been positively associated with PCa death. We investigated the association of total and age-specific adult weight trajectories with PCa aggressiveness and death.</p><p>METHODS: We analyzed data from 258,494 men in Sweden with at least 3 weight observations between ages 17 and 60. Individual weight trajectories were estimated using linear mixed-effects models with natural cubic and linear splines for age, incorporating random intercepts and slopes. These estimates were included in multivariable-adjusted Cox proportional hazards models.</p><p>RESULTS: Over a median follow-up of 25 years, 22 055 men were diagnosed with PCa and 4547 died from the disease. Steep weight gain was inversely associated with PCa diagnosed during the PSA testing era (1997 onwards) and via asymptomatic PSA testing, but not with aggressive PCa. Among men with PCa, steep weight gain was associated with increased risk of PCa death (HR quintile 5 vs. 1 = 1.23, 95% CI = 1.08 to 1.40), primarily driven by weight gain between ages 45 and 60 (HR per 1 kg/year = 1.31, 95% CI = 1.10 to 1.57).</p><p>CONCLUSIONS: The associations observed for incident PCa appear to be influenced by PSA testing uptake; however, the extent to which detection bias contributes remains uncertain. Conversely, late midlife weight gain was associated with an elevated risk of PCa death, underscoring the importance of weight management during this period as a potentially modifiable factor for reducing PCa death.</p>}},
  author       = {{da Silva, Marisa and Fritz, Josef and Elhakeem, Ahmed and Jochems, Sylvia H J and Sun, Ming and Mboya, Innocent B and Häggström, Christel and Wahlström, Jens and Michaëlsson, Karl and Magnusson, Patrik K E and Lagerros, Ylva T and Lönnberg, Lena and Chabok, Abbas and Elmståhl, Sölve and Nwaru, Bright I and Kankaanranta, Hannu and Hedman, Linnea and Backman, Helena and Hägg, Sara and Stattin, Pär and Tilling, Kate and Stocks, Tanja}},
  issn         = {{1460-2105}},
  keywords     = {{Humans; Male; Prostatic Neoplasms/epidemiology; Middle Aged; Sweden/epidemiology; Incidence; Adult; Weight Gain; Obesity/complications; Risk Factors; Adolescent; Body-Weight Trajectory; Prostate-Specific Antigen/blood; Young Adult; Proportional Hazards Models; Follow-Up Studies; Body Mass Index}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  pages        = {{1006--1014}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of the National Cancer Institute}},
  title        = {{Weight trajectories throughout adulthood and prostate cancer incidence, aggressiveness, and death in 258 494 men}},
  url          = {{http://dx.doi.org/10.1093/jnci/djag014}},
  doi          = {{10.1093/jnci/djag014}},
  volume       = {{118}},
  year         = {{2026}},
}