PURPOSE: Androgen deprivation therapy (ADT) may increase diabetes risk.
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As benefits of primary ADT (PADT) for localized PCa are controversial, and most PCa survivors are of advanced age with comorbidities, it is important to determine if PADT increases diabetes risk and what are the susceptibility factors.
MATERIALS AND METHODS: We conducted a retrospective cohort study of 12,191 men diagnosed with incident localized PCa during 1995-2008, aged 35-100 years, and without diabetes or receipt of prostatectomy or radiation one year after diagnosis. Patients were enrolled in one of three managed health plans and followed through 2010. PADT was defined as ADT within 1 year after diagnosis. Incident diabetes was ascertained using inpatient and outpatient diagnosis codes, diabetes medications, and hemoglobin A1c values. We estimated PADT-associated diabetes risk using Cox-proportional hazards models in both conventional and propensity score analyses.
RESULTS: 1,203 (9.9%) patients developed diabetes during follow-up (median 4.8 years) with incidence rates of 2.5 and 1.6 events per 100 person-years in the PADT and non-PADT group, respectively. PADT was associated with a 1.61-fold increased diabetes risk (95% C.I. =1.38-1.88). Number-needed-to-harm was 29. The association was stronger in men ≤ 70 years than in older men (HR=2.25 versus 1.40, p-value for interaction=0.008).
CONCLUSIONS: PADT may increase diabetes risk by 60% and should be used with caution when managing localized PCa. Because of the consistent association between ADT and greater diabetes risk across disease states, we recommend routine screening and lifestyle interventions to reduce diabetes risk in men receiving ADT.
Tsai H, Keating NL, Van Den Eeden SK, Haque R, Cassidy-Bushrow AE, Yood MU, Smith MR, Potosky AL. Are you the author?
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Division of General Internal Medicine, Brigham and Women's Hospital and Department of Health Care Policy, Harvard Medical School, Boston, MA; Division of Research, Kaiser Permanente Northern California, Oakland, CA; Kaiser Permanente Southern California, Research & Evaluation, Pasadena, CA; Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI; Department of Epidemiology, Boston University School of Public Health, Boston, MA; Genitourinary Oncology Program, Massachusetts General Hospital, Boston, MA.
Reference: J Urol. 2014 Dec 15. pii: S0022-5347(14)05079-4.