BERKELEY, CA (UroToday.com) - While the majority of the literature was based on Caucasians, we investigated the risk of new-onset diabetes mellitus (DM) after androgen deprivation therapy (ADT) for prostate cancer in the Asian population.
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In our study, known history of dyslipidemia, impaired fasting glucose, and the use of ADT were shown to be significant risk factors of new-onset DM upon multivariate Cox regression analyses. Regular screening of DM should be considered after the initiation of ADT, especially in patients with dyslipidemia and impaired fasting glucose. Interestingly, the hazard ratio (HR) of ADT appeared to be much higher than that quoted in the Caucasian population. Whether this can be explained by the genetic and physiological differences between different ethnicities is unknown. Further studies will be needed to clarify this interesting observation.
Concerning the form of ADT, bilateral orchiectomy (HR 6.49, 95% CI 1.48-28.55, P=0.013) appeared to be associated with even more increased risk of new-onset DM when compared to gonadotropin-releasing hormone (GnRH) agonists (HR 3.34, 95% CI 1.19-9.39, P=0.022). Previous studies have shown that a low testosterone level may worsen insulin sensitivity, and hence increase the risk of DM. While bilateral orchiectomy suppresses serum testosterone to a lower level than GnRH agonists, the difference in HR may represent a dose-dependent effect of ADT on the risk of new-onset DM. Further prospective studies will be needed to confirm this postulation.
ADT may reduce prostate cancer-related morbidities and prolong survival in selected groups of patients. However, the use of ADT is also associated with many side effects, not to mention major adverse events that may be detrimental to patients. Patients should be counseled thoroughly on the potential benefits and risks of ADT before initiation of any form of hormonal therapy.
Jeremy Y.C. Teoh, MBBS, MRCSEd and Anthony C.F. Ng, FRCSEd (Urol), FHKAM (Surgery)* as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong.