Abstract
Type 2 diabetes mellitus (T2DM) has consistently been associated with decreased risk of prostate cancer; however, if this decrease is related to the use of anti‐diabetic drugs is unknown. We prospectively studied men in the comparison cohort in the Prostate Cancer data Base Sweden 3.0, with data on T2DM, use of metformin, sulfonylurea and insulin retrieved from national health care registers and demographic databases. Cox proportional hazards regression models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) of prostate cancer, adjusted for confounders. The study consisted of 612,846 men, mean age 72 years (standard deviation; SD = 9 years), out of whom 25,882 men were diagnosed with prostate cancer during follow up, mean time of 5 years (SD = 3 years). Men with more than 1 year's duration of T2DM had a decreased risk of prostate cancer compared to men without T2DM (HR = 0.85, 95% CI = 0.82–0.88) but among men with T2DM, those on metformin had no decrease (HR = 0.96, 95% CI = 0.77–1.19), whereas men on insulin (89%) or sulfonylurea (11%) had a decreased risk (HR = 0.73, 95% CI = 0.55–0.98), compared to men with T2DM not on anti‐diabetic drugs. Men with less than 1 year's duration of T2DM had no decrease in prostate cancer risk (HR = 1.11, 95% CI = 0.95–1.31). Our results gave no support to the hypothesis that metformin protects against prostate cancer as recently proposed. However, our data gave some support to an inverse association between T2DM severity and prostate cancer risk.
Highlights
Type 2 diabetes mellitus (T2DM) has consistently been associated with decreased risk of prostate cancer[1,2,3,4,5,6] and recent data have suggested that the decrease in risk is related to the use of anti-diabetic drugs.[7]
Comparison cohort in the prostate cancer data base Sweden 3.0 Our study was designed as a prospective study in the comparison cohort in the Prostate Cancer data Base Sweden (PCBaSe) 3.0, which consists of men free from prostate cancer selected from the Swedish population.[19]
Men with a duration of T2DM of more than 1 year had a decreased risk of prostate cancer compared to men without T2DM (HR 5 0.85, 95% confidence intervals (CI) 5 0.82–0.88)
Summary
Type 2 diabetes mellitus (T2DM) has consistently been associated with decreased risk of prostate cancer[1,2,3,4,5,6] and recent data have suggested that the decrease in risk is related to the use of anti-diabetic drugs.[7]. Detailed data on the date of onset of T2DM, anti-diabetic drug use and prostate cancer are necessary to investigate potential detection bias,[15,16] and other time-related biases[17,18] that could influence the association. Use of the anti-diabetic drug metformin is suspected of underlying the association In this prospective study in Sweden, metformin failed to decrease the risk of prostate cancer. Risk was decreased in association with the use of insulin or sulfonylurea These findings add some support to an inverse association between T2DM severity and prostate cancer risk. The aim of study was to assess the risk of prostate cancer for men with T2DM in a large population-based cohort study, taking duration of T2DM, use and duration of anti-diabetic drugs, prostate cancer risk categories, comorbidity and socioeconomic status into account. To investigate the role of T2DM and possible detection bias related to diagnostic activity related to lower urinary tract symptoms, we assessed the risk of benign prostatic hyperplasia for men with T2DM
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