Does a prostate cancer diagnosis affect management of pre-existing diabetes? Results from PCBaSe Sweden: a nationwide cohort study

Abstract

ObjectivesBoth prostate cancer (PCa) and type 2 diabetes mellitus (T2DM) are increasingly prevalent conditions, which frequently coexist in men. Here, we set out to specifically examine the impact of a PCa diagnosis and its treatment on T2DM treatment.SettingThis study uses observational data from Prostate Cancer database Sweden Traject.ParticipantsThe study was undertaken in a cohort of 16 778 men with T2DM, of whom 962 were diagnosed with PCa during mean follow-up of 2.5 years.Primary and secondary outcome measuresWe investigated the association between PCa diagnosis and escalation in T2DM treatment in this cohort. A treatment escalation was defined as a new or change in anti-T2DM prescription, as recorded in the prescribed drug register (ie, change from diet to metformin or sulphonylurea or insulin). We also investigated how PCa diagnosis was associated with two treatment escalations. Multivariate Cox proportional hazards regression with age as a time scale was used while adjusting for educational level and initial T2DM treatment.ResultsWe found no association between PCa diagnosis and risk of a single treatment escalation (HR 0.99, 95% CI 0.87 to 1.13). However, PCa diagnosis was associated with an increased risk of receiving two consecutive T2DM treatment escalations (HR 1.75, 95% CI 1.38 to 2.22). This increase was strongest for men on gonadotropin-releasing hormone (GnRH) agonists (HR 3.08, 95% CI 2.14 to 4.40). The corresponding HR for men with PCa not on hormonal treatment was 1.40 (95% CI 1.03 to 1.92) and for men with PCa on antiandrogens 0.91 (95% CI 0.29 to 2.82).ConclusionsMen with T2DM who are diagnosed with PCa, particularly those treated with GnRH agonists, were more likely to have two consecutive escalations in T2DM treatment. This suggests a need for closer monitoring of men with both PCa and T2DM, as coexistence of PCa and its subsequent treatments could potentially worsen T2DM control.

Use of Warfarin or Direct Oral Anticoagulants and Risk of Prostate Cancer in PCBaSe: A Nationwide Case-Control Study

“…In PCBaSe, the NPCR is linked to the Swedish Cancer Register, Cause of Death Register, Prescribed Drug Register, National Patient Register, and Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA), by use of the Swedish Personal Identity Number ( 19 , 20 ). PCBaSe contains information on date of PCa diagnosis, age at diagnosis, primary treatment, tumor stage and grade, prostate-specific antigen (PSA) levels at time of diagnosis, hospital admissions, prescribed medications and date and cause of death ( 21 , 22 ). In PCBaSe 4.0, all men diagnosed with PCa are matched with five PCa-free men residing in the same county and with the same year of birth, to serve as controls.…”

Association of type 2 diabetes mellitus and antidiabetic medication with risk of prostate cancer: a population-based case-control study

“…For every case in PCBaSe, five PCa-free control men (n = 154,812) were randomly selected from the general Swedish population by use of the personal identity number [21], matched on year of birth and county of residence. The National Diabetes Register was initiated in 1996, and data records were linked via the personal identity number to PCBaSe [1]. In 2013, approximately 92% of the prevalent cases of type 1 and type 2 diabetes mellitus were included in the National Diabetes Register.…”

“…Prostate cancer (PCa) and type 2 Diabetes Mellitus (T2DM) are prevalent conditions that often occur concomitantly [1]. Pre-existing T2DM has been associated with a decreased risk of PCa in multiple observational studies [2][3][4][5][6][7][8].…”

Association of type 2 diabetes mellitus and antidiabetic medication with risk of prostate cancer: a population-based case-control study.

“…Prostate cancer (PCa) and type 2 Diabetes Mellitus (T2DM) are prevalent conditions that often occur concomitantly [1]. Pre-existing T2DM has been associated with a decreased risk of PCa in multiple observational studies [2][3][4][5][6][7][8].…”