TY - JOUR
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 L.
AU - Kane, Christopher J.
AU - Freedland, Stephen J.
N1 - Funding Information:
Supported by National Institutes of Health grants RO1CA231219 and K24 CA160653.
Funding Information:
William J. Aronson received a grant from the National Institutes of Health for work performed as part of the current study. Stephen J. Freedland received a grant from the National Institutes of Health for work performed as part of the current study. The other authors made no disclosures.
Publisher Copyright:
© 2019 American Cancer Society
PY - 2019/8/15
Y1 - 2019/8/15
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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U2 - 10.1002/cncr.32141
DO - 10.1002/cncr.32141
M3 - Article
C2 - 31034601
AN - SCOPUS:85065174368
SN - 0008-543X
VL - 125
SP - 2861
EP - 2867
JO - Cancer
JF - Cancer
IS - 16
ER -