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We evaluated the association between BMI and management option with multivariable multinomial logistic regression analysis. The association between BMI and ds\u2010QoL was assessed using multivariable longitudinal linear regression. Regression models were adjusted for baseline domain scores, demographics, and clinicopathologic characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2378 men were included (medians [quartiles]: age 64 [59\u201369] years; BMI 27\u2009kg\/m<jats:sup>2<\/jats:sup>; 77% were non\u2010Hispanic white); 29% were obese (BMI\u2009\u2265\u200930). Accounting for demographic and clinicopathologic features, BMI\u2009\u2265\u200928\u2009kg\/m<jats:sup>2<\/jats:sup> was inversely associated with the likelihood of receiving RP (compared with RT) and became statistically significant at BMI\u00a0<jats:styled-content>\u2265<\/jats:styled-content>\u00a033\u2009kg\/m<jats:sup>2<\/jats:sup> (maximum adjusted relative risk ratio\u2009=\u00a00.80, 95% CI 0.67 to 0.95, <jats:italic>p<\/jats:italic>\u00a0=\u20090.013 for BMI\u2009\u2265\u200933 vs. 25). Conversely, BMI was not significantly associated with the likelihood of receiving AS compared with RT. After stratification by management option, obese men who underwent definitive treatment were not found to have clinically worse ds\u2010QoL. Obese men initially on AS appeared to have worse urinary incontinence than nonobese men, but this was not significant on an <jats:italic>as\u2010treated<\/jats:italic> sensitivity analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among men with localized PCa, those with BMI\u2009\u2265\u200933\u2009kg\/m<jats:sup>2<\/jats:sup> were less likely to receive surgery than radiation. Obesity was not associated with ds\u2010QoL in men undergoing definitive treatment, nor in men who remained on AS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bco2.197","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T03:45:09Z","timestamp":1667360709000},"page":"223-233","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between body mass index and localized prostate cancer management and disease\u2010specific quality of life"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4158-552X","authenticated-orcid":false,"given":"Nathan L.","family":"Samora","sequence":"first","affiliation":[{"name":"School of Medicine Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5990-4026","authenticated-orcid":false,"given":"Christopher J. D.","family":"Wallis","sequence":"additional","affiliation":[{"name":"Division of Urology University of Toronto, Mount Sinai Hospital  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li\u2010Ching","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob E.","family":"Tallman","sequence":"additional","affiliation":[{"name":"Department of Urology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiguo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Morgans","sequence":"additional","affiliation":[{"name":"Dana Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Cooperberg","sequence":"additional","affiliation":[{"name":"Department of Urology University of California  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheldon","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California Irvine  Irvine California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann S.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences Keck School of Medicine at the University of Southern California  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia","family":"Hashibe","sequence":"additional","affiliation":[{"name":"Department of Family and Preventative Medicine University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherrie","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California Irvine  Irvine California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brock","family":"O'Neil","sequence":"additional","affiliation":[{"name":"Department of Urology University of Utah Health  Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa E.","family":"Paddock","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Rutgers Cancer Institute of New Jersey  New Brunswick New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoinette","family":"Stroup","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Rutgers Cancer Institute of New Jersey  New Brunswick New Jersey USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao\u2010Cheng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Louisiana State University New Orleans School of Public Health  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuki","family":"Koyama","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center  Nashville Tennessee 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