Tsai Huei-Ting, Keating Nancy L, Van Den Eeden Stephen K, Haque Reina, Cassidy-Bushrow Andrea E, Ulcickas Yood Marianne, Smith Matthew R, Potosky Arnold L
Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC.
Division of General Internal Medicine, Brigham and Women's Hospital and Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
J Urol. 2015 Jun;193(6):1956-62. doi: 10.1016/j.juro.2014.12.027. Epub 2014 Dec 15.
Androgen deprivation therapy may increase diabetes risk. As the benefits of primary androgen deprivation therapy for localized prostate cancer are controversial, 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.
We conducted a retrospective cohort study of 12,191 men diagnosed with incident localized prostate cancer during 1995 to 2008, age 35 to 100 years, and without diabetes or receipt of prostatectomy or radiation 1 year after diagnosis. Patients were enrolled in 1 of 3 managed health plans and followed through 2010. Primary androgen deprivation therapy was defined as androgen deprivation therapy within 1 year after diagnosis. Incident diabetes was ascertained using inpatient and outpatient diagnosis codes, diabetes medications and hemoglobin A1c values. We estimated primary androgen deprivation therapy associated diabetes risk using Cox proportional hazard models in conventional and propensity score analyses.
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 (95% CI 1.38-1.88). The number needed to harm was 29. The association was stronger in men age 70 or younger than in older men (HR 2.25 vs 1.40, p value for interaction=0.008).
Primary androgen deprivation therapy may increase diabetes risk by 60% and should be used with caution when managing localized prostate cancer. 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.
雄激素剥夺治疗可能会增加患糖尿病的风险。由于原发性雄激素剥夺治疗对局限性前列腺癌的益处存在争议，且大多数前列腺癌幸存者年龄较大且伴有合并症，因此确定原发性雄激素剥夺治疗是否会增加糖尿病风险以及确定易感因素非常重要。
我们对1995年至2008年间诊断为新发局限性前列腺癌、年龄在35至100岁之间、诊断后1年内无糖尿病且未接受前列腺切除术或放疗的12191名男性进行了一项回顾性队列研究。患者被纳入3个管理式健康计划中的1个，并随访至2010年。原发性雄激素剥夺治疗定义为诊断后1年内的雄激素剥夺治疗。使用住院和门诊诊断代码、糖尿病药物和糖化血红蛋白值确定新发糖尿病。我们在传统分析和倾向评分分析中使用Cox比例风险模型估计原发性雄激素剥夺治疗相关的糖尿病风险。
在随访期间（中位时间4.8年），1203名（9.9%）患者发生了糖尿病，原发性雄激素剥夺治疗组和非原发性雄激素剥夺治疗组的发病率分别为每100人年2.5例和1.6例。原发性雄激素剥夺治疗与糖尿病风险增加1.61倍相关（95%可信区间1.38-1.88）。伤害所需人数为29。70岁及以下男性的这种关联比老年男性更强（风险比2.25对1.40，交互作用p值=0.008）。
原发性雄激素剥夺治疗可能会使糖尿病风险增加60%，在治疗局限性前列腺癌时应谨慎使用。由于雄激素剥夺治疗与不同疾病状态下更高的糖尿病风险之间存在一致的关联，我们建议对接受雄激素剥夺治疗的男性进行常规筛查和生活方式干预，以降低糖尿病风险。
