TY - JOUR
T1 - Antidiabetic drugs and prostate cancer prognosis in a Finnish population-based cohort
AU - Vihervuori, Ville J
AU - Talala, Kirsi
AU - Taari, Kimmo
AU - Lahtela, Jorma
AU - Tammela, Teuvo
AU - Auvinen, Anssi
AU - Raittinen, Paavo V. H.
AU - Murtola, Teemu J
N1 - Funding Information:
K. Taari reports personal fees from Medivation/Astellas/Pfizer, Orion, and Myovant outside the submitted work. T. Tammela reports grants from Finnish Cancer Foundation and Sigrid Juselius Foundation; other (investigator) from Bayer AG, Astellas, Janssen, and Pfizer outside the submitted work. A. Auvinen reports grants from Academy of Finland, Cancer Foundation Finland, and Hybritech (currently part of Perkin-Elmer) during the conduct of the study; personal fees from Amgen and Janssen outside the submitted work. T.J. Murtola reports grants from Pirkanmaa Hospital District during the conduct of the study; personal fees from Astellas, Janssen, Sanofi, Novartis, and Ferring outside the submitted work; as well as a patent for AroCell AB pending. No disclosures were reported by the other authors.
Funding Information:
This work was funded by competitive research grant from the Pirkanmaa Hospital District, memorial fund of Seppo Nieminen; grant number 9⨯032.
Publisher Copyright:
2021 American Association for Cancer Research.
PY - 2021/5
Y1 - 2021/5
N2 - BACKGROUND: Hyperinsulemia and glycemic control may play a role as prostate cancer prognostic factors, while use of certain antidiabetic drugs, i.e metformin, could improve the prognosis. We examined the link between anti-diabetic medication use and prostate cancer survival taking into account simultaneous use of multiple drugs.METHODS: The study cohort composed of 6,537 men in The Finnish Randomized Study of Screening for Prostate Cancer with prostate cancer diagnosed 1996-2009. Use of Medication was attained from the nationwide prescription database of the Social Insurance Institution of Finland. Median follow-up was 9.2 years post-diagnosis. 1,603 (24,5%) men had used antidiabetic medication. 771 men died of prostate cancer during the follow-up. We used multivariable-adjusted Cox regression to evaluate the risk of prostate cancer death and onset of androgen deprivation therapy (ADT) with adjustment for prostate cancer clinical characteristics, co-morbidities and use of other drugs. Separate analyses were further adjusted for blood glucose.RESULTS: Risk of prostate cancer death was higher among antidiabetic drug users overall (HR1.42, 95%CI 1.18-1.70) compared to non-users, separately among insulin and metformin users. Adjustment for blood glucose level abolished the risk increase. Risk of ADT initiation was increased among the medication users; HR1.26 (95%CI 1.05-1.49).CONCLUSIONS: Men with prostate cancer using antidiabetic medication are generally at increased risk of dying from prostate cancer compared to non-users. The risk association is driven by underlying diabetes, as adjustment for blood glucose level ameliorates the risk increase.IMPACT: Type2 diabetes should be considered as a risk factor when considering prostate cancer prognosis.
AB - BACKGROUND: Hyperinsulemia and glycemic control may play a role as prostate cancer prognostic factors, while use of certain antidiabetic drugs, i.e metformin, could improve the prognosis. We examined the link between anti-diabetic medication use and prostate cancer survival taking into account simultaneous use of multiple drugs.METHODS: The study cohort composed of 6,537 men in The Finnish Randomized Study of Screening for Prostate Cancer with prostate cancer diagnosed 1996-2009. Use of Medication was attained from the nationwide prescription database of the Social Insurance Institution of Finland. Median follow-up was 9.2 years post-diagnosis. 1,603 (24,5%) men had used antidiabetic medication. 771 men died of prostate cancer during the follow-up. We used multivariable-adjusted Cox regression to evaluate the risk of prostate cancer death and onset of androgen deprivation therapy (ADT) with adjustment for prostate cancer clinical characteristics, co-morbidities and use of other drugs. Separate analyses were further adjusted for blood glucose.RESULTS: Risk of prostate cancer death was higher among antidiabetic drug users overall (HR1.42, 95%CI 1.18-1.70) compared to non-users, separately among insulin and metformin users. Adjustment for blood glucose level abolished the risk increase. Risk of ADT initiation was increased among the medication users; HR1.26 (95%CI 1.05-1.49).CONCLUSIONS: Men with prostate cancer using antidiabetic medication are generally at increased risk of dying from prostate cancer compared to non-users. The risk association is driven by underlying diabetes, as adjustment for blood glucose level ameliorates the risk increase.IMPACT: Type2 diabetes should be considered as a risk factor when considering prostate cancer prognosis.
KW - prostate cancer
KW - type 2 diabetes
KW - anti-diabetic medication,
KW - cohort
KW - survival
U2 - 10.1158/1055-9965.EPI-19-0580
DO - 10.1158/1055-9965.EPI-19-0580
M3 - Article
C2 - 33653815
SN - 1055-9965
VL - 30
SP - 982
EP - 989
JO - Cancer Epidemiology, Biomarkers and Prevention
JF - Cancer Epidemiology, Biomarkers and Prevention
IS - 5
ER -
