DURHAM, NC — How diabetes affects the prognosis of advanced prostate cancer (PC) is not well documented, according to a new study which sought to provide more information.
“The prognosis of diabetic men with advanced prostate cancer (PC) is poorly understood and understudied, wrote researchers from the Durhan, NC, VAMC. “Hence, we studied associations between diabetes and progression to metastases, PC-specific mortality (PCSM) and all-cause mortality (ACM) in men with non-metastatic castrate-resistant PC (nmCRPC).” The VA Caribbean Healthcare System in San Juan, Puerto Rico, also participated in the study, as did universities and medical centers in the United States and Canada.
In a report in Cancer Epidemiology, Biomarkers & Prevention, the study team described how it analyzed data from men diagnosed with nmCRPC between 2000 and 2017 at eight VA healthcare centers to determine any association between diabetes and outcomes. Men with diabetes were classified according to either ICD-9/10 codes only, two hemoglobin A1c values greater than 6.4%, if they were missing ICD-9/10 codes, as well as all diabetic men and combined.1
Of 976 men with a median age of 76, 304 (31%) were determined to have 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,” according to the authors.
In multivariable-adjusted models, the researchers found that 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),” they wrote.
The authors concluded that, in men with late-stage PC, ICD-9/10 code identified diabetes is associated with better overall survival than undiagnosed’ diabetes, which is only identified by high HbA1c values.
“Our data suggest that better diabetes detection and management may improve survival in late-stage PC,” they wrote.
- Sergeyev A, Gu L, De Hoedt AM, Amling CL, et. al. Diabetes and prostate cancer outcomes in men with nonmetastatic castrate-resistant prostate cancer: Results from the SEARCH Cohort. Cancer Epidemiol Biomarkers Prev. 2023 Jun 9:EPI-22-1324. doi: 10.1158/1055-9965.EPI-22-1324. Epub ahead of print. PMID: 37294698.
