Prostate cancer aggressiveness in diabetic patients

A recently published study has suggested the possibility of an association between the aggressiveness of prostate cancer and degree of glycemic control in some patients with an existing diagnosis of diabetes. Hong et al. carried out a retrospective analysis of data from 740 South Korean patients diagnosed with localized prostate cancer between 2004 and 2008. These patients were all treated by radical prostatectomy but received no preoperative radiation or hormonal treatment. A total of 89/740 patients had a prior diagnosis of diabetes mellitus. The results of this study showed the following:

  • There were no significant differences in the preoperative and pathological parameters between those with (n = 89) and without diabetes (n = 651).
  • When only the 89 subjects with diabetes were divided into two groups according to HbA1c level (Group 1 comprised patients with an HbA1c level < 6.5 percent and Group 2 comprised patients with an HbA1c level ≥ 6.5 percent), the patients in Group 2 demonstrated a significantly higher rate of extraprostatic extension of tumor and higher pathological Gleason scores (≥ 7) than those in Group 1.
  • Also among the patients with diabetes, the HbA1c level was an independent predictor for high pathologic Gleason score and extraprostatic extension of tumor, respectively, using multivariate analyses.

The authors conclude that, although having diabetes “may not be a significant factor regarding aggressiveness of clinically localized prostate cancer, the glycemic control, as represented by HbA1c level, may be a useful preoperative predictor of aggressive tumor profile” among diabetic patients with an additional diagnosis of clinically localized prostate cancer. The “New” Prostate Cancer InfoLink would note a number of additional provisos:

  • These data are based on a small cohort of diabetic patients and would need to be replicated in other, larger cohorts.
  • The population studied was exclusively Korean, and it is possible that there is an ethnic component to this relationship that might not be evident in populations of other ethnicities.
  • On the basis of the information that we have seen to date, we were not able to ascertain whether there was also any association between how long that patients in Group 2 had had HBA1c levels ≥ 6.5 percent and their risk for more aggressive forms of prostate cancer.

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