Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy

Results from the SEARCH database

Farnoosh Nik-Ahd, Lauren E. Howard, Adva T. Eisenberg, William J. Aronson, Martha K. Terris, Matthew R. Cooperberg, Christopher Amling, Christopher J. Kane, Stephen J. Freedland

Research output: Contribution to journalArticle

Abstract

Background: Although diabetes is inversely related to prostate cancer (PC) risk, to the authors’ knowledge the impact of glycemic control on PC progression is unknown. In the current study, the authors tested the association between hemoglobin A1c (HbA1c) and long-term PC outcomes among diabetic men undergoing radical prostatectomy (RP). Methods: The authors retrospectively reviewed data regarding men undergoing RP from 2000 to 2017 at 8 Veterans Affairs hospitals. Diabetic patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes (250.x) or by an HbA1c value >6.5% at any time before RP. Cox models tested the association between HbA1c and biochemical disease recurrence (BCR), castration-resistant PC (CRPC), metastases, PC-specific mortality, and all-cause mortality. The model for BCR was adjusted for multiple variables. Due to limited events, models for long-term outcomes were adjusted for biopsy grade and prostate-specific antigen only. Results: A total of 1409 men comprised the study population. Of these, 699 patients (50%) had an HbA1c value <6.5%, 631 (45%) had an HbA1c value of 6.5% to 7.9%, and 79 (6%) had an HbA1c value ≥8.0%. Men with an HbA1c value ≥8.0% were younger (P <.001) and more likely to be black (P =.013). The median follow-up after RP was 6.8 years (interquartile range, 3.7-10.6 years). On multivariable analysis, HbA1c was not found to be associated with BCR. However, a higher HbA1c value was associated with metastasis (hazard ratio [HR], 1.21; 95% CI, 1.02-1.44 [P =.031]) and CRPC (HR, 1.27; 95% CI, 1.03-1.56 [P =.023]). Although not statistically significant, there were trends between higher HbA1c and risk of PC-specific mortality (HR, 1.24; 95% CI, 0.99-1.56 [P =.067]) and all-cause mortality (HR, 1.09; 95% CI, 0.99-1.19 [P =.058]). Conclusions: Among diabetic men undergoing RP, a higher HbA1c value was associated with metastases and CRPC. If validated in larger studies with longer follow-up, future research should test whether better glycemic control improves long-term PC outcomes.

Original languageEnglish (US)
JournalCancer
DOIs
StatePublished - Jan 1 2019

Fingerprint

Castration
Prostatectomy
Prostatic Neoplasms
Hemoglobins
Databases
Neoplasm Metastasis
International Classification of Diseases
Mortality
Recurrence
Veterans Hospitals
Prostate-Specific Antigen
Proportional Hazards Models
Biopsy

Keywords

  • castration-resistant prostate cancer
  • diabetes
  • glycemic control
  • hemoglobin A1c (HbA1c)
  • metastases
  • prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy : Results from the SEARCH database. / Nik-Ahd, Farnoosh; Howard, Lauren E.; Eisenberg, Adva T.; Aronson, William J.; Terris, Martha K.; Cooperberg, Matthew R.; Amling, Christopher; Kane, Christopher J.; Freedland, Stephen J.

In: Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Nik-Ahd, Farnoosh ; Howard, Lauren E. ; Eisenberg, Adva T. ; Aronson, William J. ; Terris, Martha K. ; Cooperberg, Matthew R. ; Amling, Christopher ; Kane, Christopher J. ; Freedland, Stephen J. / Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy : Results from the SEARCH database. In: Cancer. 2019.
@article{5e07ba0811b545a097675de19d6a90a8,
title = "Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy: Results from the SEARCH database",
abstract = "Background: Although diabetes is inversely related to prostate cancer (PC) risk, to the authors’ knowledge the impact of glycemic control on PC progression is unknown. In the current study, the authors tested the association between hemoglobin A1c (HbA1c) and long-term PC outcomes among diabetic men undergoing radical prostatectomy (RP). Methods: The authors retrospectively reviewed data regarding men undergoing RP from 2000 to 2017 at 8 Veterans Affairs hospitals. Diabetic patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes (250.x) or by an HbA1c value >6.5{\%} at any time before RP. Cox models tested the association between HbA1c and biochemical disease recurrence (BCR), castration-resistant PC (CRPC), metastases, PC-specific mortality, and all-cause mortality. The model for BCR was adjusted for multiple variables. Due to limited events, models for long-term outcomes were adjusted for biopsy grade and prostate-specific antigen only. Results: A total of 1409 men comprised the study population. Of these, 699 patients (50{\%}) had an HbA1c value <6.5{\%}, 631 (45{\%}) had an HbA1c value of 6.5{\%} to 7.9{\%}, and 79 (6{\%}) had an HbA1c value ≥8.0{\%}. Men with an HbA1c value ≥8.0{\%} were younger (P <.001) and more likely to be black (P =.013). The median follow-up after RP was 6.8 years (interquartile range, 3.7-10.6 years). On multivariable analysis, HbA1c was not found to be associated with BCR. However, a higher HbA1c value was associated with metastasis (hazard ratio [HR], 1.21; 95{\%} CI, 1.02-1.44 [P =.031]) and CRPC (HR, 1.27; 95{\%} CI, 1.03-1.56 [P =.023]). Although not statistically significant, there were trends between higher HbA1c and risk of PC-specific mortality (HR, 1.24; 95{\%} CI, 0.99-1.56 [P =.067]) and all-cause mortality (HR, 1.09; 95{\%} CI, 0.99-1.19 [P =.058]). Conclusions: Among diabetic men undergoing RP, a higher HbA1c value was associated with metastases and CRPC. If validated in larger studies with longer follow-up, future research should test whether better glycemic control improves long-term PC outcomes.",
keywords = "castration-resistant prostate cancer, diabetes, glycemic control, hemoglobin A1c (HbA1c), metastases, prostate cancer",
author = "Farnoosh Nik-Ahd and Howard, {Lauren E.} and Eisenberg, {Adva T.} and Aronson, {William J.} and Terris, {Martha K.} and Cooperberg, {Matthew R.} and Christopher Amling and Kane, {Christopher J.} and Freedland, {Stephen J.}",
year = "2019",
month = "1",
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doi = "10.1002/cncr.32141",
language = "English (US)",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",

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T1 - Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy

T2 - Results from the SEARCH database

AU - Nik-Ahd, Farnoosh

AU - Howard, Lauren E.

AU - Eisenberg, Adva T.

AU - Aronson, William J.

AU - Terris, Martha K.

AU - Cooperberg, Matthew R.

AU - Amling, Christopher

AU - Kane, Christopher J.

AU - Freedland, Stephen J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Although diabetes is inversely related to prostate cancer (PC) risk, to the authors’ knowledge the impact of glycemic control on PC progression is unknown. In the current study, the authors tested the association between hemoglobin A1c (HbA1c) and long-term PC outcomes among diabetic men undergoing radical prostatectomy (RP). Methods: The authors retrospectively reviewed data regarding men undergoing RP from 2000 to 2017 at 8 Veterans Affairs hospitals. Diabetic patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes (250.x) or by an HbA1c value >6.5% at any time before RP. Cox models tested the association between HbA1c and biochemical disease recurrence (BCR), castration-resistant PC (CRPC), metastases, PC-specific mortality, and all-cause mortality. The model for BCR was adjusted for multiple variables. Due to limited events, models for long-term outcomes were adjusted for biopsy grade and prostate-specific antigen only. Results: A total of 1409 men comprised the study population. Of these, 699 patients (50%) had an HbA1c value <6.5%, 631 (45%) had an HbA1c value of 6.5% to 7.9%, and 79 (6%) had an HbA1c value ≥8.0%. Men with an HbA1c value ≥8.0% were younger (P <.001) and more likely to be black (P =.013). The median follow-up after RP was 6.8 years (interquartile range, 3.7-10.6 years). On multivariable analysis, HbA1c was not found to be associated with BCR. However, a higher HbA1c value was associated with metastasis (hazard ratio [HR], 1.21; 95% CI, 1.02-1.44 [P =.031]) and CRPC (HR, 1.27; 95% CI, 1.03-1.56 [P =.023]). Although not statistically significant, there were trends between higher HbA1c and risk of PC-specific mortality (HR, 1.24; 95% CI, 0.99-1.56 [P =.067]) and all-cause mortality (HR, 1.09; 95% CI, 0.99-1.19 [P =.058]). Conclusions: Among diabetic men undergoing RP, a higher HbA1c value was associated with metastases and CRPC. If validated in larger studies with longer follow-up, future research should test whether better glycemic control improves long-term PC outcomes.

AB - Background: Although diabetes is inversely related to prostate cancer (PC) risk, to the authors’ knowledge the impact of glycemic control on PC progression is unknown. In the current study, the authors tested the association between hemoglobin A1c (HbA1c) and long-term PC outcomes among diabetic men undergoing radical prostatectomy (RP). Methods: The authors retrospectively reviewed data regarding men undergoing RP from 2000 to 2017 at 8 Veterans Affairs hospitals. Diabetic patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes (250.x) or by an HbA1c value >6.5% at any time before RP. Cox models tested the association between HbA1c and biochemical disease recurrence (BCR), castration-resistant PC (CRPC), metastases, PC-specific mortality, and all-cause mortality. The model for BCR was adjusted for multiple variables. Due to limited events, models for long-term outcomes were adjusted for biopsy grade and prostate-specific antigen only. Results: A total of 1409 men comprised the study population. Of these, 699 patients (50%) had an HbA1c value <6.5%, 631 (45%) had an HbA1c value of 6.5% to 7.9%, and 79 (6%) had an HbA1c value ≥8.0%. Men with an HbA1c value ≥8.0% were younger (P <.001) and more likely to be black (P =.013). The median follow-up after RP was 6.8 years (interquartile range, 3.7-10.6 years). On multivariable analysis, HbA1c was not found to be associated with BCR. However, a higher HbA1c value was associated with metastasis (hazard ratio [HR], 1.21; 95% CI, 1.02-1.44 [P =.031]) and CRPC (HR, 1.27; 95% CI, 1.03-1.56 [P =.023]). Although not statistically significant, there were trends between higher HbA1c and risk of PC-specific mortality (HR, 1.24; 95% CI, 0.99-1.56 [P =.067]) and all-cause mortality (HR, 1.09; 95% CI, 0.99-1.19 [P =.058]). Conclusions: Among diabetic men undergoing RP, a higher HbA1c value was associated with metastases and CRPC. If validated in larger studies with longer follow-up, future research should test whether better glycemic control improves long-term PC outcomes.

KW - castration-resistant prostate cancer

KW - diabetes

KW - glycemic control

KW - hemoglobin A1c (HbA1c)

KW - metastases

KW - prostate cancer

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