Abstract
BackgroundThere are conflicting results as to the association between pre-existing diabetes and the risk of mortality in patients with prostate cancer. The purpose of this study is to estimate the influence of pre-existing diabetes on prostate cancer-specific mortality and all-cause mortality.MethodsWe searched PubMed and Embase to identify studies that investigated the association between pre-existing diabetes and risk of death among men with prostate cancer. Pooled risk estimates and 95 % confidence intervals were calculated using fixed-effects models or random-effects models. Heterogeneity tests were conducted between studies. Publication bias was analyzed by using the Egger’s test, Begg’s test, and the trim and fill method.ResultsOf the 733 articles identified, 17 cohort studies that had 274,677 male patients were included in this meta-analysis. Pre-existing diabetes was associated with a 29 % increase in prostate cancer-specific mortality [relative risk (RR) 1.29, 95 % CI 1.22–1.38, I2 = 66.68 %], and with a 37 % increase in all-cause mortality (RR 1.37, 95 % CI 1.29–1.45, p < 0.01, I2 = 90.26 %). Additionally, in a subgroup analysis that was a type specific analysis focusing on type 2 diabetes and was conducted only with three cohort studies, pre-existing type 2 diabetes was associated with all-cause mortality (RR 2.01, 95 % CI 1.37–2.96, I2 = 95.55 %) and no significant association with prostate cancer-specific mortality was detected (RR 1.17, 95 % CI 0.96–1.42, I2 = 75.59 %). There was significant heterogeneity between studies and no publication bias was found.ConclusionsThis meta-analysis suggests diabetes may result in a worse prognosis for men with prostate cancer. Considering heterogeneity between studies, additional studies should be conducted to confirm these findings, and to allow generalization regarding the influence that each type of diabetes has on prostate cancer mortality.
Highlights
There are conflicting results as to the association between pre-existing diabetes and the risk of mortality in patients with prostate cancer
This study included only prior studies that had prospective and retrospective cohort designs, in order to understand the association between pre-existing diabetes and the prospect of prostate cancer mortality
In our ancillary analysis, which only included results from patients with pre-existing type 2 diabetes, we found that patients with prostate cancer with type 2 diabetes had a doubling in all-cause mortality
Summary
There are conflicting results as to the association between pre-existing diabetes and the risk of mortality in patients with prostate cancer. The purpose of this study is to estimate the influence of pre-existing diabetes on prostate cancer-specific mortality and all-cause mortality. In 2015, the American Cancer Society reported that 1 in 7 men will be diagnosed with prostate cancer during his lifetime (Jemal et al 2011). The known risk factors for prostate cancer include age, ethnicity, and family history (Jemal et al 2011). The prevalence of type 2 diabetes has rapidly escalated owing to the increase in obesity, which increases the risk of various cancers (Baba et al 2011). Hyperinsulinemia was hypothesized as the link between type 2 diabetes and the risk of various
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