Causes of Death in Men With Prevalent Diabetes and Newly Diagnosed High- Versus Favorable-Risk Prostate Cancer
Received 21 April 2009; received in revised form 25 June 2009; accepted 26 June 2009. published online 30 October 2009.
Purpose
To determine whether prevalent diabetes mellitus (pDM) affects the presentation, extent of radiotherapy, or prostate cancer (PCa)-specific mortality (PCSM) and whether PCa aggressiveness affects the risk of non-PCSM, DM-related mortality, and all-cause mortality in men with pDM.
Methods
Between October 1997 and July 2907, 5,279 men treated at the Chicago Prostate Cancer Center with radiotherapy for PCa were included in the study. Logistic and competing risk regression analyses were performed to assess whether pDM was associated with high-grade PCa, less aggressive radiotherapy, and an increased risk of PCSM. Competing risks and Cox regression analyses were performed to assess whether PCa aggressiveness described by risk group in men with pDM was associated with the risk of non-PCSM, DM-related mortality, and all-cause mortality. Analyses were adjusted for predictors of high-grade PCa and factors that could affect treatment extent and mortality.
Results
Men with pDM were more likely (adjusted hazard ratio [AHR], 1.9; 95% confidence interval [CI], 1.3–2.7; p = .002) to present with high-grade PCa but were not treated less aggressively (p = .33) and did not have an increased risk of PCSM (p = .58) compared to men without pDM. Among the men with pDM, high-risk PCa was associated with a greater risk of non-PCSM (AHR, 2.2; 95% CI, 1.1–4.5; p = .035), DM-related mortality (AHR, 5.2; 95% CI, 2.0–14.0; p = .001), and all-cause mortality (AHR, 2.4; 95% CI, 1.2–4.7; p = .01) compared to favorable-risk PCa.
Conclusion
Aggressive management of pDM is warranted in men with high-risk PCa.
∗Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA
†Department of Radiation Oncology, Prostate Cancer Foundation of Chicago, Westmont, IL
‡Department of Statistics, University of Connecticut, Storrs, CT
Reprint requests to: Anthony V. D'Amico, M.D., Ph.D., Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St., L-2 Level, Boston, MA 02215. Tel: (617) 632-6328; Fax: (617) 632-216
ABSTRACT