The impact of metformin use on the risk of prostate cancer after prostate biopsy in patients with high grade intraepithelial neoplasia.

Lucio Dell'Atti,Andrea B Galosi

doi:10.1590/s1677-5538.ibju.2017.0046

Abstract

ABSTRACTPurposeWe report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis.Materials and MethodsWe retrospectively analyzed 551 patients with a diagnosis of HGPIN without PCa in a first prostate biopsy. The cohort of the study consisted of 456 nondiabetic subjects, and 95 diabetic patients. Among the patients with diabetes 44 were treated with metformin, and 51 with other antidiabetic drugs. A transrectal ultrasound prostate biopsy scheme with 22 cores was carried out 4-6 months after the first diagnosis of HGPIN.ResultsAmong 195 (35.4%) patients with cancer, there were statistically significant differences in terms of PCa detection (p<0.001), Gleason score distribution (p<0.001), and number of positive biopsy cores (p<0.002) between metformin users and non-users. Metformin use was associated with a decreased risk of PCa compared with neveruse (p<0.001). Moreover, increasing duration of metformin assumption (≥2 years) was associated with decreasing incidence of PCa and higher Gleason score ≥7 compared with assumption <2 years.ConclusionsThis preliminary experience suggests that metformin use may have some beneficial effects in patients with diabetes and HGPIN; metformin should not be overlooked in these patients because it is neither new nor expensive.

Highlights

Prostate cancer (PCa) is the first most common cancer in men worldwide, and the prostate biopsy is the only modality to diagnose this disease [1]
We report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis
Decision for a first TRUSBx was based upon high prostatic specific antigen (PSA) levels and/or suspicious digital rectal examination (DRE) findings according to EAU (European Association Urology) guidelines

Summary

Introduction

Prostate cancer (PCa) is the first most common cancer in men worldwide, and the prostate biopsy is the only modality to diagnose this disease [1]. Not diagnostic of PCa on a needle biopsy, many epidemiological, molecular, histopathological, and genetic studies have offered strong evidences that high-grade prostatic intraepithelial neoplasia (HGPIN) is a precursor lesion to development of invasive PCa [2]. An oral biguanide, is the first line therapy for many patients with type 2 diabetes [4, 5]. We report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis

Methods

Findings

Discussion

Conclusion