UroToday - In the September 10, 2008 issue of the Journal of Clinical Oncology, Dr. Matthew Smith and his colleagues reported on the association of diabetes mellitus (DM) and death in men treated for prostate cancer (CaP) with radiotherapy and androgen deprivation therapy (ADT). The authors cited a meta-analysis whereby an inverse relationship between diabetes and CaP diagnosis was noted. This report used the database from RTOG 92-02 in which men with CaP were randomized to radiotherapy with either 4 months of ADT or 24 months of extended ADT. The primary endpoint was cause of death.

In total, 1,551 patients were enrolled in the study: 763 to the short-term ADT and 758 to long-term ADT. Median age was 70 years and patients with DM had significantly greater body weight as well as lower PSA levels. In univariate analysis, DM was significantly associated with greater all-cause and non-CaP mortality, but not CaP mortality. In multivariate analysis, age, race, Gleason score, tumor stage, PSA, treatment arm and weight were controlled for. In this model, DM was significantly associated with both greater all-cause mortality and non-CaP mortality. DM was not associated with greater CaP mortality. Tumor stage and Gleason score, age, greater weight and treatment arm were significantly associated with CaP mortality. In both treatment arms, DM was associated with greater all-cause and non-CaP mortality, but not CaP mortality.

The authors suggested that the association of greater weight, but not DM with increased CaP mortality, indicates that mechanisms other than diabetic metabolic alterations account for death.

Smith MR, Bae K, Efstathiou JA, Hanks GE, Pilepich MV, Sandler HM, Shipley WU
J Clin Oncol. 2008 Sep 10;26(26):4333-9
10.1200/JCO.2008.16.5845

Written by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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