|
1
|
Khan S, Cai J, Nielsen ME, Troester MA, Mohler JL, Fontham ETH, Hendrix LH, Farnan L, Olshan AF, Bensen JT. The Association of Diabetes and Obesity With Prostate Cancer Progression: HCaP-NC. Prostate 2017; 77:878-887. [PMID: 28261834 PMCID: PMC5695861 DOI: 10.1002/pros.23342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 02/13/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of race in modifying the association among diabetes, obesity, and prostate cancer (CaP) progression is not well studied. We evaluated diabetes and obesity in association with time to CaP progression in White Americans (Whites) and Black Americans (Blacks). METHODS Our study sample consisted of 363 White and 284 Black research participants from the Health Care Access and CaP Treatment in North Carolina (HCaP-NC) cohort. The association between self-reported diabetes or obesity and CaP progression (mean follow-up time approximately 5 years) was assessed using Cox proportional hazards modeling, with adjustment for potential confounders. Stratum-specific hazard ratio (HR) estimates for Whites and Blacks were evaluated. RESULTS Self-reported diabetes was not associated with CaP progression in the cohort as a whole (HR: 0.86, 95%CI: 0.54, 1.35), or among racially defined groups (Whites, HR: 1.03, 95%CI: 0.50, 2.13 or Blacks, HR: 0.77, 95%CI: 0.43, 1.39). Obesity was positively associated with CaP progression among Whites, in models including (HR: 1.79, 95%CI: 1.08, 2.97), and excluding (HR: 1.80, 95%CI: 1.09, 2.96) diabetes as a covariate. No association was observed between obesity and CaP progression in Blacks or the cohort as whole. CONCLUSIONS Self-reported diabetes was not associated with CaP progression In HCaP-NC. Obesity was associated with CaP progression only among White research participants. Prostate 77:878-887, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Saira Khan
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E. Nielsen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Department of Urology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Melissa A. Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - James L. Mohler
- Department of Urology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
- Department of Urology, University of Buffalo School of Medicine and Biotechnology, Buffalo, New York
| | - Elizabeth T. H. Fontham
- School of Public Health, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Laura H. Hendrix
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Laura Farnan
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jeannette T. Bensen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
|
2
|
Kovalainen E, Vaarala MH. Prostate-specific antigen nadir concentration, hypertension and diabetes as risk factors for biochemical failure after permanent 125I seed brachytherapy for prostate cancer. Mol Clin Oncol 2016; 5:647-650. [PMID: 27900104 DOI: 10.3892/mco.2016.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/18/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to evaluate risk factors for biochemical failure (BF) following permanent prostate seed 125I brachytherapy for prostate cancer. The study reviewed the medical records of 607 patients with biopsy-proven prostate adenocarcinoma who were treated at Oulu University Hospital between 2001 and 2014. Clinical characteristics at diagnosis, treatment-related data and follow-up data were collected to identify potential risk factors for BF, which was defined using the Phoenix criteria [prostate-specific antigen (PSA) increase >2 µg/l from the PSA nadir concentration, which defined as the lowest PSA concentration observed after BT]. The median follow-up was 81 months. BF was detected in 117 (19.3%) patients. The PSA nadir concentration was associated with BF. The mean times to BF were 114 [95% confidence interval (CI): 112-116] and 55 (95% CI: 47-63) months for patients with PSA nadir concentrations <0.5 and ≥0.5 µg/l, respectively (P<0.001). Patients with underlying hypertension or diabetes tended to develop BF more rapidly. For patients without and with hypertension, the mean times to BF were 104 (95% CI: 100-107) and 98 (95% CI: 93-103) months, respectively (P=0.035). For patients without and with diabetes, the mean times to BF were 103 (95% CI: 100-106) and 89 (95% CI: 77-102) months, respectively (P=0.006). The overall survival and prostate cancer-specific survival rates were 90.3 and 98.0%, respectively. The mean overall survival and prostate-cancer specific survival times were 147 and 158 months, respectively. Therefore, PSA nadir level was identified as a clear risk factor for BF. In addition, BF tended to develop more rapidly among patients with underlying hypertension or diabetes. These risk factors should be considered, and individually tailored follow-up may be useful for identifying patients requiring more intense follow-up for early BF detection.
Collapse
Affiliation(s)
- Essi Kovalainen
- Department of Operative Care, Division of Urology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
| | - Markku H Vaarala
- Department of Operative Care, Division of Urology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
| |
Collapse
|
|
3
|
Lee J, Giovannucci E, Jeon JY. Diabetes and mortality in patients with prostate cancer: a meta-analysis. SPRINGERPLUS 2016; 5:1548. [PMID: 27652121 PMCID: PMC5021649 DOI: 10.1186/s40064-016-3233-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are conflicting results as to the association between pre-existing diabetes and the risk of mortality in patients with prostate cancer. The purpose of this study is to estimate the influence of pre-existing diabetes on prostate cancer-specific mortality and all-cause mortality. METHODS We searched PubMed and Embase to identify studies that investigated the association between pre-existing diabetes and risk of death among men with prostate cancer. Pooled risk estimates and 95 % confidence intervals were calculated using fixed-effects models or random-effects models. Heterogeneity tests were conducted between studies. Publication bias was analyzed by using the Egger's test, Begg's test, and the trim and fill method. RESULTS Of the 733 articles identified, 17 cohort studies that had 274,677 male patients were included in this meta-analysis. Pre-existing diabetes was associated with a 29 % increase in prostate cancer-specific mortality [relative risk (RR) 1.29, 95 % CI 1.22-1.38, I(2) = 66.68 %], and with a 37 % increase in all-cause mortality (RR 1.37, 95 % CI 1.29-1.45, p < 0.01, I(2) = 90.26 %). Additionally, in a subgroup analysis that was a type specific analysis focusing on type 2 diabetes and was conducted only with three cohort studies, pre-existing type 2 diabetes was associated with all-cause mortality (RR 2.01, 95 % CI 1.37-2.96, I(2) = 95.55 %) and no significant association with prostate cancer-specific mortality was detected (RR 1.17, 95 % CI 0.96-1.42, I(2) = 75.59 %). There was significant heterogeneity between studies and no publication bias was found. CONCLUSIONS This meta-analysis suggests diabetes may result in a worse prognosis for men with prostate cancer. Considering heterogeneity between studies, additional studies should be conducted to confirm these findings, and to allow generalization regarding the influence that each type of diabetes has on prostate cancer mortality.
Collapse
Affiliation(s)
- Junga Lee
- Department of Sport and Leisure Studies, Yonsei University, Seoul, South Korea ; Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University, Seoul, South Korea
| | - Edward Giovannucci
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA USA
| | - Justin Y Jeon
- Department of Sport and Leisure Studies, Yonsei University, Seoul, South Korea ; Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University, Seoul, South Korea
| |
Collapse
|
|
4
|
Polesel J, Gini A, Dal Maso L, Stocco C, Birri S, Taborelli M, Serraino D, Zucchetto A. The impact of diabetes and other metabolic disorders on prostate cancer prognosis. J Diabetes Complications 2016; 30:591-6. [PMID: 26936307 DOI: 10.1016/j.jdiacomp.2016.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/29/2016] [Accepted: 02/07/2016] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the impact of diabetes mellitus (DM) and other metabolic disorders on the survival of men with prostate cancer (PCa). METHODS We conducted a retrospective cohort-study based on 715 men with PCa, originally enrolled in an Italian case-control study between 1995 and 2002. Anthropometric measures, self-reported medical conditions, and Gleason score were assessed at enrollment. Adjusted hazard ratios (HRs) of death, with 95% confidence intervals (95% CIs), were estimated using Fine and Gray's regression model. RESULTS After a median follow-up of 11.6years, 244 (34.1%) deaths occurred, 77 (31.6%) due to PCa. Excess mortality from all causes was reported in PCa patients with DM (HR=1.56, 95% CI: 1.03-2.36), which increased to 1.76 (95% CI: 0.99-3.13) when at least two out of three metabolic disorders (i.e., waist circumference ≥102cm, drug-treated hypertension, and hypercholesterolemia) were additionally present. The impact of metabolic disorders was stronger on non-PCa-specific mortality with HRs equal to 2.21 (95% CI: 1.38-3.54) for DM, 1.45 (95% CI: 0.97-2.19) for waist circumference ≥102cm, and 1.63 (95% CI: 1.19-2.22) for drug-treated hypertension. CONCLUSIONS DM and other metabolic disorders unfavorably affected the survival of PCa patients, mainly impacting on the risk of death from causes other than PCa.
Collapse
Affiliation(s)
- Jerry Polesel
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Andrea Gini
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Luigino Dal Maso
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Carmen Stocco
- Venetian Cancer Registry, Istituto Oncologico Veneto, Passaggio Gaudenzio 1, 35131 Padua (PD), Italy.
| | - Silvia Birri
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Martina Taborelli
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Diego Serraino
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Antonella Zucchetto
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, via Franco Gallini 2, 33081 Aviano (PN), Italy.
| |
Collapse
|
|
5
|
Cai H, Xu Z, Xu T, Yu B, Zou Q. Diabetes mellitus is associated with elevated risk of mortality amongst patients with prostate cancer: a meta-analysis of 11 cohort studies. Diabetes Metab Res Rev 2015; 31:336-43. [PMID: 25066306 DOI: 10.1002/dmrr.2582] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE Diabetes mellitus is associated with a decreased risk of prostate cancer. However, previous studies examining the associations between diabetes mellitus and prostate cancer prognosis have produced mixed results. Here, we aim to summarize the effect of diabetes mellitus on prostate cancer prognosis. METHODS We searched the database of PubMed from inception through 31 March 2014 for articles evaluating the effect of diabetes on outcome in prostate cancer patients, and a meta-analysis was conducted. RESULTS A total of 11 cohort studies were included in this meta-analysis, of which seven studies were carried out to investigate whether diabetes mellitus is associated with all-cause mortality amongst those with prostate cancer, seven studies to investigate whether diabetes mellitus is associated with prostate cancer-specific mortality and two studies to investigate the relationship of diabetes mellitus and nonprostate cancer mortality. The meta-analysis results suggested that diabetes mellitus could significantly affect the incidence of all-cause mortality amongst those with prostate cancer (hazard ratio = 1.50, 95% confidence interval = 1.25-1.79). Besides, diabetes mellitus was also associated with prostate cancer-specific mortality (hazard ratio = 1.26, 95% confidence interval = 1.20-1.33) and nonprostate cancer mortality (hazard ratio = 1.83, 95% confidence interval = 1.33-2.52) separately. There was no obvious publication bias amongst the studies included. CONCLUSION The results of this meta-analysis reveal an association of diabetes mellitus with adverse prognosis amongst those with prostate cancer. The biological basis of the association of diabetes mellitus with prostate cancer incidence and prognosis remains unclear. Doctors could pay more attention to prostate patients with pre-existing diabetes mellitus, and more aggressive treatment regimens should be considered.
Collapse
Affiliation(s)
- Hongzhou Cai
- Department of Urologic Surgery, Nanjing Medical University Affiliated Cancer Hospital of Jiangsu Province, Nanjing, China
| | | | | | | | | |
Collapse
|
|
6
|
Margel D, Urbach DR, Lipscombe LL, Bell CM, Kulkarni G, Baniel J, Fleshner N, Austin PC. Is pathology necessary to predict mortality among men with prostate-cancer? BMC Med Inform Decis Mak 2014; 14:114. [PMID: 25495664 PMCID: PMC4275978 DOI: 10.1186/s12911-014-0114-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 11/17/2014] [Indexed: 02/19/2023] Open
Abstract
Background Statistical models developed using administrative databases are powerful and inexpensive tools for predicting survival. Conversely, data abstraction from chart review is time-consuming and costly. Our aim was to determine the incremental value of pathological data obtained from chart abstraction in addition to information acquired from administrative databases in predicting all-cause and prostate cancer (PC)-specific mortality. Methods We identified a cohort of men with diabetes and PC utilizing population-based data from Ontario. We used the c-statistic and net-reclassification improvement (NRI) to compare two Cox- proportional hazard models to predict all-cause and PC-specific mortality. The first model consisted of covariates from administrative databases: age, co-morbidity, year of cohort entry, socioeconomic status and rural residence. The second model included Gleason grade and cancer volume in addition to all aforementioned variables. Results The cohort consisted of 4001 patients. The accuracy of the admin-data only model (c-statistic) to predict 5-year all-cause mortality was 0.7 (95% CI 0.69-0.71). For the extended model (including pathology information) it was 0.74 (95% CI 0.73-0.75). This corresponded to a change in category of predicted probability of survival among 14.8% in the NRI analysis. The accuracy of the admin-data model to predict 5-year PC specific mortality was 0.76 (95% CI 0.74-0.78). The accuracy of the extended model was 0.85 (95% CI 0.83-0.87). Corresponding to a 28% change in the NRI analysis. Conclusions Pathology chart abstraction, improved the accuracy in predicting all-cause and PC-specific mortality. The benefit is smaller for all-cause mortality, and larger for PC-specific mortality.
Collapse
Affiliation(s)
- David Margel
- Division of Urology, Rabin Medical Center, Beilinson Campus, 39 Jabotinsky, Petah Tikva, 4941492, Israel. .,Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
| | - David R Urbach
- Departments of Surgery and Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Division of Clinical Decision Making and Health Care, Toronto General Hospital Research Institute, Toronto, Canada. .,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Cancer Care Ontario, Ontario, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Lorraine L Lipscombe
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Medicine, Women's College Hospital and Research Institute, University of Toronto, Toronto, Canada.
| | - Chaim M Bell
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Medicine and Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Girish Kulkarni
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Beilinson Campus, 39 Jabotinsky, Petah Tikva, 4941492, Israel.
| | - Neil Fleshner
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
| |
Collapse
|
|
7
|
Strine AC, Rice KR, Masterson TA. Metabolic syndrome in the development and progression of prostate cancer. World J Clin Urol 2014; 3:168-183. [DOI: 10.5410/wjcu.v3.i3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/12/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer (PCa) is the most common noncutaneous malignancy and second leading cause of cancer-specific mortality for men in the United States. There is a wide spectrum of aggressiveness ranging from biologically significant to indolent disease, which has led to an interest in the identification of risk factors for its development and progression. Emerging evidence has suggested an association between metabolic syndrome (MetS) and PCa. MetS represents a cluster of metabolic derangements that confer an increased risk of cardiovascular disease and type 2 diabetes mellitus. Its individual components include obesity, dyslipidemias, high blood pressure, and high fasting glucose levels. MetS has become pervasive and is currently associated with a high socioeconomic cost in both industrialized and developing countries throughout the world. The relationship between MetS and PCa is complex and yet to be fully defined. A better understanding of this relationship will facilitate the development of novel therapeutic targets for the prevention of PCa and improvement of outcomes among diagnosed men in the future. In this review, we evaluate the current evidence on the role of MetS in the development and progression of PCa. We also discuss the clinical implications on the management of PCa and consider the future direction of this subject.
Collapse
|
|
8
|
Abstract
BACKGROUND The absence of evidence-based guidelines for prostate cancer treatment led the Institute of Medicine to include localized prostate cancer treatment among the 25 most important topics for comparative effectiveness research. OBJECTIVE This study compared prostate cancer treatment and survival in men with and without prevalent comorbid conditions. RESEARCH DESIGN The sample comprised elderly men, aged 66 years and older, extracted from SEER-Medicare data, between 2004 and 2009 (N=73,563). Treatment and survival for men with at least 1 of 4 prevalent comorbid conditions were compared with men who did not have any of the 12 Charlson comorbid conditions. The sample was stratified by comorbid condition and low-risk, intermediate-risk, and high-risk disease. RESULTS Over half of men received some form of cancer-directed treatment, irrespective of comorbid condition. Men who have congestive heart failure (CHF) or multiple comorbid conditions were less likely to be treated, whereas men with diabetes were more likely to be treated. With the exception of men with CHF, men with comorbid conditions and low-risk disease received no survival benefit from any type of treatment. CONCLUSIONS Most men received treatment, particularly radiation therapy, regardless of comorbid condition. The evidence suggests more caution should be used when treating men with low-risk disease and comorbid conditions as they are at risk for adverse events and additional medical costs, without a survival benefit.
Collapse
|
|
9
|
Type 2 diabetes and the risk of mortality among patients with prostate cancer. Cancer Causes Control 2014; 25:329-38. [DOI: 10.1007/s10552-013-0334-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/24/2013] [Indexed: 02/06/2023]
|
|
10
|
Wu C, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, Freedland SJ. Diabetes predicts metastasis after radical prostatectomy in obese men: results from the SEARCH database. BJU Int 2013; 111:E310-8. [PMID: 23305170 DOI: 10.1111/j.1464-410x.2012.11687.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association between diabetes and metastasis risk after radical prostatectomy (RP) and to determine if race or obesity modifies this relationship. PATIENTS AND METHODS Patients comprised 2058 US veterans with prostate cancer (PCa) enrolled in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database and treated with RP between 1988 and 2010. The association of diabetes with metastasis risk or secondary treatment rates was examined using Cox proportional hazards, adjusting for preoperative and, separately, clinical and postoperative findings. The effect modification by race (black vs white) and obesity (body mass index [BMI] ≥30 vs <30 kg/m(2) ) was tested via interaction terms. RESULTS Men with diabetes had higher BMIs and were more likely to be non-white (all P ≤ 0.001). On multivariable analysis, diabetes was not associated with metastasis risk (P ≥ 0.45), but, among men with diabetes, longer diabetes duration was associated with higher metastasis risk (P ≤ 0.035). When stratified by obesity, diabetes was linked with higher metastasis risk in obese but not in non-obese men (P-interaction ≤ 0.037), but there was no significant interaction with race (P-interaction ≥ 0.56). Diabetes also predicted more aggressive secondary treatment among obese men but less aggressive treatment among non-obese men (hazard ratio 1.39 vs 0.63, P-interaction = 0.006). Where applicable, results were similar for both pre- and postoperative models. CONCLUSIONS Diabetes was not associated with metastasis risk overall. Stratification by obesity yielded significant differences, with diabetes linked to a fourfold higher metastasis risk in obese men, despite predicting more aggressive secondary treatment. Longer diabetes duration was also associated with increased metastasis risk.
Collapse
Affiliation(s)
- Chenwei Wu
- Duke University School of Medicine, Durham, NC, USA
| | | | | | | | | | | | | |
Collapse
|