Diabetes A Risk For Men Treated With Androgen Deprivation for Localized Prostate Cancer

June 2, 2015. Primary androgen deprivation therapy for localized prostate cancer increases diabetes risk by up to 60 per cent, particularly in men under 70 years of age, according to research published in the June issue of The Journal of Urology.

"As the benefits of primary androgen deprivation therapy for localized prostate cancer are controversial," the authors say, "and most prostate cancer survivors are of advanced age with comorbidities, it is important to determine if primary androgen deprivation therapy increases the risk of diabetes and to determine the susceptibility factors."

Huei-Ting Tsai, Ph.DHuei-Ting Tsai, Ph.D., from the Georgetown University Medical Center in Washington, D.C., and colleagues looked back over medical records of 12,191 men diagnosed incidentally with localized prostate cancer during 1995 to 2008. The men's ages ranged from 35 to 100 years. These patients, all enrolled in 1 of 3 managed health plans, were followed through 2010.

None of the men showed signs of diabetes at the time prostate cancer was found. A year after diagnosis, none of the men had been treated with prostatectomy or radiation. Instead, within one year following diagnosis, they had all received androgen deprivation therapy as a primary treatment.

Onset of diabetes following start of androgen blockade was ascertained using inpatient and outpatient diagnosis codes, diabetes medications and hemoglobin A1c values. Diabetes developed in 1,203 (9.9%) patients during followup (median 4.8 years) with incidence rates of 2.5 and 1.6 events per 100 person-years in the primary androgen deprivation therapy and nonprimary androgen deprivation therapy groups, respectively.

Primary androgen deprivation therapy was associated with a 1.61-fold increased diabetes risk. The number needed to harm was 29. The association was stronger in men age 70 or younger than in older men.

"Primary androgen deprivation therapy may increase diabetes risk by 60% and should be used with caution when managing localized prostate cancer" the authors state. "Because of the consistent association between androgen deprivation therapy and greater diabetes risk across disease states, we recommend routine screening and lifestyle interventions to reduce the risk of diabetes in men receiving androgen deprivation therapy."

Notes and Sources

Dr. Tsai is an Assistant Professor of Oncology at the Georgetown University Medical Center. Her page at Lombardi says "Dr. Tsai uses her expertise in pharmacoepidemiology and patient-centered outcomes research to examine the array of emerging therapies in cancer care to enhance quality of cancer care."

Risk of Diabetes among Patients Receiving Primary Androgen Deprivation Therapy for Clinically Localized Prostate Cancer is published in June 2015 issue of The Journal of Urology, Volume 193, Issue 6, Pages 1956–1962

Incident (or incidentally detected) prostate cancer is found not through early detection or screening but, typically, when the patient undergoes surgery for obstructive symptoms caused by presumed benign prostatic hyperplasia (BPH).

Androgen Deprivation as a primary treatment has adverse effects beyond risk of diabetes and does not extend life. In 2014 another study, cinducted by several leading US cancer centers, concluded that primary androgen deprivation therapy (pADT) "is detrimental to men with localized prostate cancer, and particularly men with longer life expectancy. Therefore, we conclude that ADT should not be used as a primary treatment for men with prostate cancer that has not spread beyond the prostate."
Patterns of Declining Use and the Adverse Effect of Primary Androgen Deprivation on All-cause Mortality in Elderly Men with Prostate Cancer. Eur Urol. 2014 Oct 29.