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Sergeyev A, Gu L, De Hoedt AM, Amling CL, Aronson WJ, Cooperberg MR, Kane CJ, Klaassen Z, Terris MK, Guerrios-Rivera L, Freedland SJ, Csizmadi I. Diabetes and Prostate Cancer Outcomes in Men with Nonmetastatic Castration-Resistant Prostate Cancer: Results from the SEARCH Cohort. Cancer Epidemiol Biomarkers Prev 2023; 32:1208-1216. [PMID: 37294698 PMCID: PMC10529387 DOI: 10.1158/1055-9965.epi-22-1324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/27/2023] [Accepted: 06/07/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND The prognosis of diabetic men with advanced prostate cancer is poorly understood and understudied. Hence, we studied associations between diabetes and progression to metastases, prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) in men with nonmetastatic castration-resistant prostate cancer (nmCRPC). METHODS Data from men diagnosed with nmCRPC between 2000 and 2017 at 8 Veterans Affairs Health Care Centers were analyzed using Cox regression to determine HRs and 95% confidence intervals (CI) for associations between diabetes and outcomes. Men with diabetes were classified according to: (i) ICD-9/10 codes only, (ii) two HbA1c values > 6.4% (missing ICD-9/10 codes), and (iii) all diabetic men [(i) and (ii) combined]. RESULTS Of 976 men (median age: 76 years), 304 (31%) had diabetes at nmCRPC diagnosis, of whom 51% had ICD-9/10 codes. During a median follow-up of 6.5 years, 613 men were diagnosed with metastases, and 482 PCSM and 741 ACM events occurred. In multivariable-adjusted models, ICD-9/10 code-identified diabetes was inversely associated with PCSM (HR, 0.67; 95% CI, 0.48-0.92) while diabetes identified by high HbA1c values (no ICD-9/10 codes) was associated with an increase in ACM (HR, 1.41; 95% CI, 1.16-1.72). Duration of diabetes, prior to CRPC diagnosis was inversely associated with PCSM among men identified by ICD-9/10 codes and/or HbA1c values (HR, 0.93; 95% CI, 0.88-0.98). CONCLUSIONS In men with late-stage prostate cancer, ICD-9/10 'code-identified' diabetes is associated with better overall survival than 'undiagnosed' diabetes identified by high HbA1c values only. IMPACT Our data suggest that better diabetes detection and management may improve survival in late-stage prostate cancer.
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Affiliation(s)
- Andrei Sergeyev
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Lin Gu
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | | | | | | | - Matthew R. Cooperberg
- University of California San Francisco Medical Center, San Francisco, California, USA
| | - Christopher J. Kane
- University of California San Diego Health System, San Diego, California, USA
| | | | | | | | - Stephen J. Freedland
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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Swaby J, Aggarwal A, Batra A, Jain A, Seth L, Stabellini N, Bittencourt MS, Leong D, Klaassen Z, Barata P, Sayegh N, Agarwal N, Terris M, Guha A. Association of Androgen Deprivation Therapy with Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis. Clin Genitourin Cancer 2022; 21:e182-e189. [PMID: 36621463 DOI: 10.1016/j.clgc.2022.12.006] [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: 09/19/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT), a backbone treatment for advanced prostate cancer (PC), is known to have a variety of metabolic side effects. We conducted an updated meta-analysis to quantify the metabolic risks of ADT. MATERIALS AND METHODS We searched PubMed, Web of Science, and Scopus in May of 2022 for studies investigating the risk of metabolic syndrome (MetS), diabetes, and hypertension from ADT in PC patients using keywords. Only full-length studies with a control group of PC patients not on ADT were included. All results compatible with each outcome domain in each included study were sought. For included studies, relative risk (RR) was pooled using a random effects model and a trim-fill approach was used to adjust for publication bias. RESULTS 1,846 records were screened, of which 19 were found suitable for data extraction. Five studies, including 891 patients, were evaluated for MetS as an outcome, with the random effects model showing a pooled RR of 1.60 ([95% Confidence Interval (CI), 1.06-2.42]; P=0.03) for patients on ADT while twelve studies, including 336,330 patients, examined diabetes as an outcome, and the random effects model showed a RR of 1.43 ([95% CI, 1.28-1.59]; P< 0.01). After adjustment for publication bias, ADT was associated with a 25% increased risk for diabetes but was not associated with MetS. 4 studies, including 7,051 patients, examined hypertension as an outcome, and the random effects model showed a RR of 1.30 ([95% CI, 1.08-1.55]; P=0.18) in ADT patients. CONCLUSION In patients with PC, ADT was not associated with MetS and the association with diabetes was not as strong as previously reported. Our novel meta-analysis of hypertension showed that ADT increased the risk of hypertension by 30%. These results should be understood in the context of collaborating care between a patient's oncologist and primary care provider to optimize care.
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Affiliation(s)
- Justin Swaby
- Department of Cardiovascular Disease, Augusta University, Augusta, GA
| | | | - Akshee Batra
- Department of Internal Medicine, University of Vermont, Burlington, VT
| | - Anubhav Jain
- Department of Cardiology, Ascension Genesys Hospital, Garden city, MI
| | - Lakshya Seth
- Department of Cardiovascular Disease, Augusta University, Augusta, GA
| | - Nickolas Stabellini
- Department of Hematology- Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Darryl Leong
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | - Pedro Barata
- Genitourinary Medical Oncology, Tulane University Medical School, New Orleans, LA
| | | | | | - Martha Terris
- Division of Surgery: Urology, Augusta University, Augusta, GA
| | - Avirup Guha
- Department of Cardiovascular Disease, Augusta University, Augusta, GA.
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Bahl A, Rajappa S, Rawal S, Bakshi G, Murthy V, Patil K. A review of clinical evidence to assess differences in efficacy and safety of luteinizing hormone-releasing hormone (LHRH) agonist (goserelin) and LHRH antagonist (degarelix). Indian J Cancer 2022; 59:S160-S174. [PMID: 35343199 DOI: 10.4103/ijc.ijc_1415_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Luteinizing hormone-releasing hormone agonist (LHRH-A), goserelin, and antagonist, degarelix, are both indicated for the treatment of advanced prostate cancer (PCa); however, large comparative trials evaluating their efficacy and safety are lacking. In this review, we assessed the available evidence for both the drugs. Although degarelix achieves an early rapid decline in testosterone (T) and prostate-specific antigen (PSA) levels, median T and PSA levels, in addition to prostate volume and International Prostate Symptom Scores, become comparable with goserelin over the remaining treatment period. Degarelix causes no initial flare, therefore it is recommended in patients with spinal metastases or ureteric obstruction. Goserelin achieves lower PSA, improved time to progression, and better survival outcomes when administered adjunctively to radiotherapy compared with radiotherapy alone, with significant results even over long-term follow-up. The evidence supporting adjuvant degarelix use is limited. Goserelin has better injection site safety, single-step delivery, and an efficient administration schedule compared with degarelix, which has significantly higher injection site reactions and less efficient administration mechanism. There is conflicting evidence about the risk of cardiovascular disease (CVD), and caution is required when using LHRH-A in patients with preexisting CVD. There is considerable long-term evidence for goserelin in patients with advanced PCa, with degarelix being a more recent option. The available comparative evidence of goserelin versus degarelix has several inherent limitations related to study design, sample size, conduct, and statistical analyses, and hence warrants robust prospective trials and long-term follow-up.
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Affiliation(s)
- Ankur Bahl
- Senior Consultant, Medical Oncology and Hematology, Max Cancer Centre, New Delhi, India
| | - Senthil Rajappa
- Consultant Medical Oncologist, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Sudhir Rawal
- Medical Director, Chief Genito Uro-Oncology, RCGI, Delhi, India
| | - Ganesh Bakshi
- Department of Uro oncology, P D Hinduja National Hospital, Mahim, Mumbai, India
| | - Vedang Murthy
- Professor & Radiation Oncologist, Tata Memorial Center, Mumbai, India
| | - Ketaki Patil
- Medical Affairs, AstraZeneca Pharma India Ltd, Manyatha Tech Park, Rachenahalli, Bangalore, India
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Lin E, Garmo H, Van Hemelrijck M, Adolfsson J, Stattin P, Zethelius B, Crawley D. Exploring the association between use of gonadotropin releasing hormones agonists and prostate cancer diagnosis per se and diabetes control in men with type 2 diabetes mellitus: a nationwide, population-based cohort study. BMC Cancer 2021; 21:1259. [PMID: 34809595 PMCID: PMC8607667 DOI: 10.1186/s12885-021-08941-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gonadotropin Releasing Hormones agonists (GnRH), which are first line treatment for metastatic prostate cancer (PCa), increase risk of type 2 diabetes mellitus (T2DM). This study aims to quantify the association of use of GnRH with diabetes control in PCa men with T2DM. METHODS Nationwide population-based cohort study in the Swedish National Diabetes Register and Prostate Cancer data Base Sweden 4.1, on the association between GnRH and diabetes control in T2DM men with PCa by comparing T2DM men with PCa vs. without PCa, as well as comparing T2DM men with PCa on or not on GnRH. The primary exposure was use of GnRH. Worsening diabetes control was the primary outcome, defined as: 1) HbA1c rose to 58 mmol/mol or higher; 2) HbA1c increase by 10 mmol/mol or more; 3) Start of antidiabetic drugs or switch to insulin. We also combined all above definitions. Cox proportional hazards regression was used to analyze the association. RESULTS There were 5714 T2DM men with PCa of whom 692 were on GnRH and 28,445 PCa-free men with T2DM with similar baseline characteristics. Diabetes control was worse in men with GnRH vs. PCa-free men (HR: 1.24, 95% CI: 1.13-1.34) as well as compared with PCa men without GnRH (HR:1.58, 95% CI: 1.39-1.80), when we defined the worsening control of diabetes by combining all definitions above. CONCLUSION Use of GnRH in T2DM men with PCa was associated with worse glycemic control. The findings highlight the need to closely monitor diabetes control in men with T2DM and PCa starting GnRH.
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Affiliation(s)
- E Lin
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
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Development of diabetes mellitus following hormone therapy in prostate cancer patients is associated with early progression to castration resistance. Sci Rep 2021; 11:17157. [PMID: 34433857 PMCID: PMC8387479 DOI: 10.1038/s41598-021-96584-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022] Open
Abstract
To identify risk factors for the prognosis of prostate cancer (PC), we retrospectively analyzed the impact of lifestyle-related disorders as well as PC characteristics at initial diagnosis on the progression to castration-resistant PC (CRPC) in PC patients undergoing hormone therapy. Of 648 PC patients, 230 who underwent hormone therapy and met inclusion criteria were enrolled in this study. CRPC developed in 48 patients (20.9%). Univariate analysis using Cox proportional hazard model indicated that newly developed diabetes mellitus (DM) following hormone therapy (postDM), but not preexisting DM, as well as PC characteristics at initial diagnosis including prostate-specific antigen (PSA) ≥ 18 were significantly associated with the progression to CRPC. A similar tendency was also observed in the relationship between newly developed hypertension following hormone therapy and CRPC progression. On the other hand, neither dyslipidemia nor hyperuricemia, regardless the onset timing, exhibited any association with CRPC progression. In multivariate analysis, postDM and PSA ≥ 18 were extracted as independent risk factors for CRPC progression (adjusted hazard ratios, 3.38 and 2.34; p values, 0.016 and 0.019, respectively). Kaplan–Meier analysis and log-rank test clearly indicated earlier progression to CRPC in PC patients who developed postDM or had relatively advanced initial PC characteristics including PSA ≥ 18. Together, the development of lifestyle-related disorders, particularly DM, following hormone therapy, as well as advanced PC characteristics at initial diagnosis is considered to predict earlier progression to CRPC and poor prognosis in PC patients undergoing hormone therapy.
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Drevinskaite M, Patasius A, Kincius M, Urbonas V, Smailyte G. Retrospective cohort study of androgen deprivation therapy and the risk of diabetes in men with prostate cancer in Lithuania. BMJ Open 2021; 11:e045797. [PMID: 34321292 PMCID: PMC8319979 DOI: 10.1136/bmjopen-2020-045797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To examine the risk of type 2 diabetes in patients with prostate cancer and its association with androgen deprivation therapy (ADT). DESIGN AND PARTICIPANTS We performed a retrospective cohort study of patients diagnosed with prostate cancer in the Lithuanian male population between 1 January 2003 and 31 December 2012 who were identified through the Lithuanian Cancer registry. All prostate cancer cases were linked to the National Health Insurance Fund database to obtain information regarding the diagnosis of diabetes mellitus and information on prescriptions of antiandrogens and gonadotropin-releasing hormone (GnRH) agonists. Patients with prostate cancer were followed up until the diagnosis of type 2 diabetes, or 31 December 2017, or date of death, whichever came first. Cox proportional hazard models were used to estimate the risk of type 2 diabetes in patients with prostate cancer with or without ADT exposure. RESULTS 27 580 men were diagnosed with prostate cancer, out of whom 14 502 (52.6%) did not receive ADT and 13 078 (47.4%) were treated with ADT. The incidence of type 2 diabetes for all patients with prostate cancer was 7.4/1000 person-years, for men on GnRH agonists 9.0/1000 person-years and 5.8/1000 person-years for men on antiandrogens. There was an increased risk of developing type 2 diabetes comparing ADT users and non-users (HR=1.49, 95% CI 1.34 to 1.66). CONCLUSION This study showed an increased risk of diabetes in patients with prostate cancer treated with ADT in comparison to ADT-free patient cohort. GnRH agonist users showed higher susceptibility, while the group on antiandrogen monotherapy showed no such increase.
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Affiliation(s)
- Mingaile Drevinskaite
- Laboratory of Cancer Epidemiology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ausvydas Patasius
- Laboratory of Cancer Epidemiology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
- Faculty of Medicine, Institute of Health Sciences, Vilniaus Universitetas, Vilnius, Lithuania
| | - Marius Kincius
- Laboratory of Clinical Oncology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
| | - Vincas Urbonas
- Laboratory of Clinical Oncology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, Nacionalinis Vėžio Institutas, Vilnius, Lithuania
- Faculty of Medicine, Institute of Health Sciences, Vilniaus Universitetas, Vilnius, Lithuania
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Cheung AS, Hoermann R, Zhu J, Lim Joon D, Zajac JD, Grossmann M. Zoledronic acid does not affect insulin resistance in men receiving androgen deprivation therapy: a prespecified secondary analysis of a randomised controlled trial. Ther Adv Endocrinol Metab 2021; 12:20420188211012118. [PMID: 34104395 PMCID: PMC8111529 DOI: 10.1177/20420188211012118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/02/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Animal studies suggest that undercarboxylated osteocalcin may improve insulin sensitivity via its effect on testicular testosterone production. Human studies have been conflicting. Men undergoing androgen deprivation therapy (ADT) for prostate cancer experience profound hypogonadism resulting in increased insulin resistance. In a randomised controlled trial (RCT) of zoledronic acid versus placebo in men commencing extended-duration ADT, we aimed to examine the effects on fat mass and glucose metabolism. We hypothesised that zoledronic acid, which reduces osteocalcin concentrations, would worsen ADT-induced insulin resistance. METHODS This was a prespecified secondary analysis of an RCT designed to evaluate the effects of zoledronic acid on bone microarchitecture in 76 men with non-metastatic prostate cancer undergoing curative radiotherapy combined with adjuvant ADT (n = 39 randomised to a single dose of zoledronic acid 5 mg, n = 37 randomised to matching placebo). Oral glucose tolerance tests to determine Matsuda Index were performed at 0, 3, 12 and 24 months. Using a mixed model, mean adjusted differences [MAD (95% confidence interval)] between the groups over time are reported. RESULTS Over 24 months of ADT, fat mass increased and lean mass decreased for both groups, with no significant between group difference [MAD 401 g (-1307; 2103), p = 0.23 and -184 g (-1325; 955), p = 0.36 respectively]. Bone remodelling markers C-telopeptide [MAD -176 ng/l (-275; -76), p < 0.001 and P1NP -18 mg/l (-32; -5), p < 0.001] as a surrogate for osteocalcin, remained significantly lower in the zoledronic acid group, compared with placebo. There was no mean adjusted between-group difference for homeostatic model assessment 2 insulin resistance (HOMA2-IR) [-0.2 (-0.6; 0.2), p = 0.45], HbA1c [-0.1% (-0.3; 0.1), p = 0.64] or Matsuda Index [0.8 (-1.1; 2.7), p = 0.38]. The Matsuda Index decreased in both groups consistent with worsening insulin resistance with ADT. CONCLUSION A single dose of zoledronic acid does not appear to influence glucose metabolism in men newly commencing ADT. Further study to evaluate the endocrine relationship between bisphosphonates, bone and glucose metabolism is required. TRIAL REGISTRATION NUMBER [ClinicalTrials.gov identifier: NCT01006395].
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Affiliation(s)
- Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Rudolf Hoermann
- Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | - Jasmine Zhu
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Austin Health, Heidelberg, VIC, Australia
| | - Jeffrey D. Zajac
- Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
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Jo A, Scarton L, O'Neal LJ, Larson S, Schafer N, George TJ, Munoz Pena JM. New onset of type 2 diabetes as a complication after cancer diagnosis: A systematic review. Cancer Med 2021; 10:439-446. [PMID: 33355998 PMCID: PMC7877369 DOI: 10.1002/cam4.3666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite improved survival rates, cancer survivors are experiencing worse health outcomes with complications of treatment, such as type 2 diabetes mellitus (T2D), that may deteriorate survivorship. The purpose of this review was to provide a comprehensive review of T2D incidence following cancer diagnosis. METHODS The study included: (1) cohort studies, (2) cancer diagnosis by a doctor, (3) incidence of T2D after diagnosis of cancer, and (4) adult patients over 18 years. Studies that focused on patients who had T2D as a preexisting condition at cancer diagnosis were excluded. RESULTS Of a total of 16 studies, overall incidence of T2D ranged from 5.4% to 55.3%. The highest T2D incidence rate was observed in colorectal patients with cancer (53%). While results in prostate patients with cancer were mixed, patients who underwent androgen deprivation therapy (ADT) had a significantly higher incidence of new-onset T2D (12.8%, p = 0.01). Patients treated with chemotherapy within 1-5 years of initial diagnosis of colorectal cancer were at approximately 30% higher risk of T2D. One study found that 48% of T2D was preventable with optimal management during the process of patient care. CONCLUSION Blood glucose management may allow physicians to intervene early and improve outcomes among patients with cancer.
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Affiliation(s)
- Ara Jo
- Department of Health Services Research, Management and PolicyUniversity of FloridaGainesvilleFLUSA
| | - Lisa Scarton
- Department of Family Community and Health Systems ScienceCollege of NursingUniversity of FloridaGainesvilleFLUSA
| | - LaToya J. O'Neal
- Department of Family, Youth and Community SciencesInstitute of Food and Agricultural SciencesUniversity of FloridaGainesvilleFLUSA
| | - Samantha Larson
- Department of Health Services Research, Management and PolicyUniversity of FloridaGainesvilleFLUSA
| | - Nancy Schafer
- Health Science LibraryUniversity of FloridaGainesvilleFLUSA
| | - Thomas J. George
- Division of Hematology and OncologyCollege of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Juan M. Munoz Pena
- Division of Endocrinology, Diabetes, and MetabolismCollege of MedicineUniversity of FloridaGainesvilleFLUSA
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Haider KS, Haider A, Saad F, Doros G, Hanefeld M, Dhindsa S, Dandona P, Traish A. Remission of type 2 diabetes following long-term treatment with injectable testosterone undecanoate in patients with hypogonadism and type 2 diabetes: 11-year data from a real-world registry study. Diabetes Obes Metab 2020; 22:2055-2068. [PMID: 32558149 PMCID: PMC7689919 DOI: 10.1111/dom.14122] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022]
Abstract
AIMS To investigate whether testosterone therapy (TTh) in men with hypogonadism and type 2 diabetes mellitus (T2DM) improves glycaemic control and insulin sensitivity, and results in remission of T2DM. MATERIAL AND METHODS A total of 356 men who had total testosterone levels ≤12.1 nmol/L (350 ng/dL) and symptoms of hypogonadism were included in the study and followed up for 11 years. All patients received standard diabetes treatment and 178 patients additionally received parenteral testosterone undecanoate 1000 mg every 12 weeks following an initial 6-week interval. A control group comprised 178 hypogonadal patients who opted not to receive TTh. RESULTS Patients with hypogonadism and T2DM treated with testosterone had significant progressive and sustained reductions in fasting glucose, glycated haemoglobin (HbA1c) and fasting insulin over the treatment period. In the control group, fasting glucose, HbA1c and fasting insulin increased. Among the patients treated with testosterone 34.3% achieved remission of their diabetes and 46.6% of patients achieved normal glucose regulation. Of the testosterone-treated group, 83.1% reached the HbA1c target of 47.5 mmol/mol (6.5%) and 90% achieved the HbA1c target of 53.0 mmol/mol (7%). In contrast, no remission of diabetes or reductions in glucose or HbA1c levels were noted in the control group. There were fewer deaths, myocardial infarctions, strokes and diabetic complications in the testosterone-treated group. CONCLUSIONS Long-term TTh in men with T2DM and hypogonadism improves glycaemic control and insulin resistance. Remission of diabetes occurred in one-third of the patients. TTh is potentially a novel additional therapy for men with T2DM and hypogonadism.
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Affiliation(s)
| | | | - Farid Saad
- Consultant to Medical Affairs Andrology, Bayer AGBerlinGermany
- Research DepartmentGulf Medical University School of MedicineAjmanUnited Arab Emirates
| | - Gheorghe Doros
- Department of Epidemiology and BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Markolf Hanefeld
- Zentrum für klinische StudienGWT‐TU Dresden GmbHDresdenGermany
- Medizinische Klinik 3Universitätsklinikum Carl Gustav CarusDresdenGermany
| | - Sandeep Dhindsa
- Division of Endocrinology, Diabetes and MetabolismSaint Louis UniversitySt. LouisMissouriUSA
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and MetabolismState University of New York at BuffaloNew YorkUSA
- Internal Medicine ‐ EndocrinologyKaleida HealthBuffaloNew YorkUSA
| | - Abdulmaged Traish
- Department of UrologyBoston University School of MedicineBostonMassachusettsUSA
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Franko A, Berti L, Guirguis A, Hennenlotter J, Wagner R, Scharpf MO, de Angelis MH, Wißmiller K, Lickert H, Stenzl A, Birkenfeld AL, Peter A, Häring HU, Lutz SZ, Heni M. Characterization of Hormone-Dependent Pathways in Six Human Prostate-Cancer Cell Lines: A Gene-Expression Study. Genes (Basel) 2020; 11:E1174. [PMID: 33036464 PMCID: PMC7599530 DOI: 10.3390/genes11101174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer (PCa), the most incident cancer in men, is tightly regulated by endocrine signals. A number of different PCa cell lines are commonly used for in vitro experiments, but these are of diverse origin, and have very different cell-proliferation rates and hormone-response capacities. By analyzing the gene-expression pattern of main hormone pathways, we systematically compared six PCa cell lines and parental primary cells. We compared these cell lines (i) with each other and (ii) with PCa tissue samples from 11 patients. We found major differences in the gene-expression levels of androgen, insulin, estrogen, and oxysterol signaling between PCa tissue and cell lines, and between different cell lines. Our systematic characterization gives researchers a solid basis to choose the appropriate PCa cell model for the hormone pathway of interest.
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Affiliation(s)
- Andras Franko
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Lucia Berti
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Alke Guirguis
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Jörg Hennenlotter
- Department of Urology, University Hospital Tübingen, 72076 Tübingen, Germany; (J.H.); (A.S.)
| | - Robert Wagner
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Marcus O. Scharpf
- Institute of Pathology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Martin Hrabĕ de Angelis
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Institute of Experimental Genetics, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Katharina Wißmiller
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany;
- Institute of Stem Cell Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Department of Medicine, Technical University of Munich, 81675 München, Germany
| | - Heiko Lickert
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany;
- Institute of Stem Cell Research, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Department of Medicine, Technical University of Munich, 81675 München, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, 72076 Tübingen, Germany; (J.H.); (A.S.)
| | - Andreas L. Birkenfeld
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
| | - Stefan Z. Lutz
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Clinic for Geriatric and Orthopedic Rehabilitation Bad Sebastiansweiler, 72116 Mössingen, Germany
| | - Martin Heni
- Department of Internal Medicine IV, Division of Diabetology, Endocrinology, and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (R.W.); (A.L.B.); (H.-U.H.); (S.Z.L.); (M.H.)
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany; (M.H.d.A.); (H.L.)
- Department for Diagnostic Laboratory Medicine, Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany;
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11
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Franko A, Berti L, Hennenlotter J, Rausch S, Scharpf MO, de Angelis MH, Stenzl A, Birkenfeld AL, Peter A, Lutz SZ, Häring HU, Heni M. Transcript Levels of Aldo-Keto Reductase Family 1 Subfamily C (AKR1C) Are Increased in Prostate Tissue of Patients with Type 2 Diabetes. J Pers Med 2020; 10:jpm10030124. [PMID: 32932589 PMCID: PMC7564141 DOI: 10.3390/jpm10030124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023] Open
Abstract
Aldo-keto reductase family 1 (AKR1) enzymes play a crucial role in diabetic complications. Since type 2 diabetes (T2D) is associated with cancer progression, we investigated the impact of diabetes on AKR1 gene expression in the context of prostate cancer (PCa) development. In this study, we analyzed benign (BEN) prostate and PCa tissue of patients with and without T2D. Furthermore, to replicate hyperglycemia in vitro, we treated the prostate adenocarcinoma cell line PC3 with increasing glucose concentrations. Gene expression was quantified using real-time qPCR. In the prostate tissue of patients with T2D, AKR1C1 and AKR1C2 transcripts were higher compared to samples of patients without diabetes. In PC3 cells, high glucose treatment induced the gene expression levels of AKR1C1, C2, and C3. Furthermore, both in human tissue and in PC3 cells, the transcript levels of AKR1C1, C2, and C3 showed positive associations with oncogenes, which are involved in proliferation processes and HIF1α and NFκB pathways. These results indicate that in the prostate glands of patients with T2D, hyperglycemia could play a pivotal role by inducing the expression of AKR1C1, C2, and C3. The higher transcript level of AKR1C was furthermore associated with upregulated HIF1α and NFκB pathways, which are major drivers of PCa carcinogenesis.
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Affiliation(s)
- Andras Franko
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (A.L.B.); (S.Z.L.); (H.-U.H.)
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
| | - Lucia Berti
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
| | - Jörg Hennenlotter
- Department of Urology, University Hospital Tübingen, 72076 Tübingen, Germany; (J.H.); (S.R.); (A.S.)
| | - Steffen Rausch
- Department of Urology, University Hospital Tübingen, 72076 Tübingen, Germany; (J.H.); (S.R.); (A.S.)
| | - Marcus O. Scharpf
- Institute of Pathology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Martin Hrabĕ de Angelis
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
- Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tübingen, 72076 Tübingen, Germany; (J.H.); (S.R.); (A.S.)
| | - Andreas L. Birkenfeld
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (A.L.B.); (S.Z.L.); (H.-U.H.)
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, 72076 Tübingen, Germany; (A.P.)
| | - Stefan Z. Lutz
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (A.L.B.); (S.Z.L.); (H.-U.H.)
- Clinic for Geriatric and Orthopedic Rehabilitation Bad Sebastiansweiler, 72116 Mössingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (A.L.B.); (S.Z.L.); (H.-U.H.)
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
| | - Martin Heni
- Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University Hospital Tübingen, 72076 Tübingen, Germany; (A.F.); (A.L.B.); (S.Z.L.); (H.-U.H.)
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Munich, University of Tübingen, 72076 Tübingen, Germany;
- German Center for Diabetes Research (DZD), 85764 Neuherberg, Germany;
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, 72076 Tübingen, Germany; (A.P.)
- Correspondence: ; Tel.: +49-7071-29-82714
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Abstract
PURPOSE OF REVIEW As more people live longer with cancer, the number of patients with cancer and multiple other chronic conditions (multimorbidity) has increased. The presence of multimorbidity impacts on all stages of cancer care, from prevention and early detection through to end of life care, but research into cancer and multimorbidity is in its infancy. This review explores the impact of multimorbidity on adults living with (and beyond) cancer, with particular attention paid to the role of primary care in supporting patients in this situation. RECENT FINDINGS Patterns of multimorbidity vary depending on cancer type and stage, as well as population characteristics and available data (e.g. number of conditions assessed). Cancer survivors are at increased risk of developing other chronic conditions, due to a combination of shared risk factors (e.g. smoking and obesity), effects of cancer treatments and psychosocial effects. SUMMARY Primary care has a central role to play in supporting multimorbid adults living with cancer, providing holistic care of physical and mental well being, while taking treatment burden and social circumstances into account. New models of person-centred and personalized cancer care include holistic needs assessments, care planning, treatment summaries and cancer care reviews, and depend on improved communication between oncologists and primary care colleagues.
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13
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Quantifying observational evidence for risk of dementia following androgen deprivation therapy for prostate cancer: an updated systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2020; 24:15-23. [PMID: 32814845 DOI: 10.1038/s41391-020-00267-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) administration was recently reported and might be positively associated with dementia. However, the existing studies showed controversial results. The aim of this study was to evaluate the relationship between ADT and the risk of dementia through a meta-analysis. METHODS Original articles published up to March 2020 were retrieved from Embase, Pubmed, the Cochrane library, and Web of Science for studies focusing on associations between ADT for prostate cancer (PCa) and incidence of dementia. A meta-analysis was conducted using a hazard ratio (HR) and 95% confidence interval (CI) as effect measures. Heterogeneity between the studies was examined using I2 statistics. Subgroup analyses, sensitivity analyses, and meta-regression were conducted, and publication bias was assessed by Egger's test. RESULTS Thirteen studies were included in this systematic review. Eleven cohort studies involving 339,400 cases and 436,851 controls were included in the main meta-analysis. ADT administration was associated with a 21% increase in dementia risk (pooled HR = 1.21, 95% CI: 1.13-1.30, P < 0.001). Subgroup analyses based on ADT types showed that luteinizing hormone-releasing hormone agonists (HR = 1.14, P < 0.001), bilateral orchiectomy (HR = 1.42, P < 0.001), oral antiandrogens (HR = 1.35, P = 0.138), and combined androgen blockade (HR = 1.22, P = 0.097) were positively related to subsequent risk of dementia, although the differences were not statistically significant with oral antiandrogens and combined androgen blockade. CONCLUSIONS The current study indicated that ADT administration, no matter with types of ADT, is associated with the risk of dementia in patients with PCa. Future studies are needed to determine whether ADT causes dementia or is merely associated with increased risk.
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14
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Lin YT, Lee MTS, Huang YC, Liu CK, Li YT, Chen M. Prediction of Recurrence-associated Death from Localized Prostate Cancer with a Charlson Comorbidity Index-reinforced Machine Learning Model. Open Med (Wars) 2019; 14:593-606. [PMID: 31428684 PMCID: PMC6698054 DOI: 10.1515/med-2019-0067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022] Open
Abstract
Research has failed to resolve the dilemma experienced by localized prostate cancer patients who must choose between radical prostatectomy (RP) and external beam radiotherapy (RT). Because the Charlson Comorbidity Index (CCI) is a measurable factor that affects survival events, this research seeks to validate the potential of the CCI to improve the accuracy of various prediction models. Thus, we employed the Cox proportional hazard model and machine learning methods, including random forest (RF) and support vector machine (SVM), to model the data of medical records in the National Health Insurance Research Database (NHIRD). In total, 8581 individuals were enrolled, of whom 4879 had received RP and 3702 had received RT. Patients in the RT group were older and exhibited higher CCI scores and higher incidences of some CCI items. Moderate-to-severe liver disease, dementia, congestive heart failure, chronic pulmonary disease, and cerebrovascular disease all increase the risk of overall death in the Cox hazard model. The CCI-reinforced SVM and RF models are 85.18% and 81.76% accurate, respectively, whereas the SVM and RF models without the use of the CCI are relatively less accurate, at 75.81% and 74.83%, respectively. Therefore, CCI and some of its items are useful predictors of overall and prostate-cancer-specific survival and could constitute valuable features for machine-learning modeling.
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Affiliation(s)
- Yi-Ting Lin
- Department of Urology, St. Joseph Hospital, Yunlin County, 63241, Taiwan.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Michael Tian-Shyug Lee
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Yen-Chun Huang
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Chih-Kuang Liu
- Department of Urology, St. Joseph Hospital, Yunlin County, 63241, Taiwan.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Yi-Tien Li
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City 24205, Taiwan
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15
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Wei L, Lai ECC, Kao-Yang YH, Walker BR, MacDonald TM, Andrew R. Incidence of type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors: population based cohort study. BMJ 2019; 365:l1204. [PMID: 30971393 PMCID: PMC6456811 DOI: 10.1136/bmj.l1204] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To investigate the incidence of new onset type 2 diabetes mellitus in men receiving steroid 5α-reductase inhibitors (dutasteride or finasteride) for long term treatment of benign prostatic hyperplasia. DESIGN Population based cohort study. SETTING UK Clinical Practice Research Datalink (CPRD; 2003-14) and Taiwanese National Health Insurance Research Database (NHIRD; 2002-12). PARTICIPANTS Men in the CPRD who received dutasteride (n=8231), finasteride (n=30 774), or tamsulosin (n=16 270) were evaluated. Propensity score matching (2:1; dutasteride to finasteride or tamsulosin) produced cohorts of 2090, 3445, and 4018, respectively. In the NHIRD, initial numbers were 1251 (dutasteride), 4194 (finasteride), and 86 263 (tamsulosin), reducing to 1251, 2445, and 2502, respectively, after propensity score matching. MAIN OUTCOMES MEASURE Incident type 2 diabetes using a Cox proportional hazard model. RESULTS In the CPRD, 2081 new onset type 2 diabetes events (368 dutasteride, 1207 finasteride, and 506 tamsulosin) were recorded during a mean follow-up time of 5.2 years (SD 3.1 years). The event rate per 10 000 person years was 76.2 (95% confidence interval 68.4 to 84.0) for dutasteride, 76.6 (72.3 to 80.9) for finasteride, and 60.3 (55.1 to 65.5) for tamsulosin. There was a modest increased risk of type 2 diabetes for dutasteride (adjusted hazard ratio 1.32, 95% confidence interval 1.08 to 1.61) and finasteride (1.26, 1.10 to 1.45) compared with tamsulosin. Results for the NHIRD were consistent with the findings for the CPRD (adjusted hazard ratio 1.34, 95% confidence interval 1.17 to 1.54 for dutasteride, and 1.49, 1.38 to 1.61 for finasteride compared with tamsulosin). Propensity score matched analyses showed similar results. CONCLUSIONS The risk of developing new onset type 2 diabetes appears to be higher in men with benign prostatic hyperplasia exposed to 5α-reductase inhibitors than in men receiving tamsulosin, but did not differ between men receiving dutasteride and those receiving finasteride. Additional monitoring might be required for men starting these drugs, particularly in those with other risk factors for type 2 diabetes.
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Affiliation(s)
- Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yea-Huei Kao-Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Brian R Walker
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas M MacDonald
- Medicines Monitoring Unit, Ninewells Hospital and Medical School, Dundee, UK
| | - Ruth Andrew
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK
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