The prognosis of diabetic men with advanced prostate cancer (PC) is poorly understood and understudied. 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).
Data from men diagnosed with nmCRPC between 2000 and 2017 at 8 Veterans Affairs Health Care Centers were analyzed using Cox regression to determine hazard ratios (HRs) and 95% confidence intervals (CIs) 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).
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).
In men with late-stage PC, ICD-9/10 code identified diabetes is associated with better overall survival than 'undiagnosed' diabetes identified by high HbA1c values only.
Our data suggest that better diabetes detection and management may improve survival in late-stage PC.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2023 Jun 09 [Epub ahead of print]
Andrei Sergeyev, Lin Gu, Amanda M De Hoedt, Christopher L Amling, William J Aronson, Matthew R Cooperberg, Christopher J Kane, Zachary Klaassen, Martha K Terris, Lourdes Guerrios-Rivera, Stephen J Freedland, Ilona Csizmadi
Durham VA Medical Center, Durham, North Carolina, United States., Durham VA Medical Center, United States., Durham VA Health Care System, Durham, North Carolina, United States., Oregon Health Sciences University, Portland, OR., David Geffen School of Medicine at UCLA, Los Angeles, CA, United States., University of California, San Francisco, San Francisco, CA, United States., University of California, San Diego, La Jolla, CA, United States., Augusta University, United States., Augusta University, Augusta, Georgia, United States., VA Caribbean Healthcare System & University of Puerto Rico, San Juan, Puerto Rico, Puerto Rico., Cedars-Sinai Medical Center, Los Angeles, CA, United States., University of Calgary, Calgary, Alberta, Canada.