Blood glucose, glucose balance and disease-specific survival after prostate cancer diagnosis in the Finnish Randomized Study of Screening for Prostate Cancer
Sälli, Samueli (2020)
2020
Lääketieteen lisensiaatin tutkinto - Licentiate of Medicine
Lääketieteen ja terveysteknologian tiedekunta - Faculty of Medicine and Health Technology
This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.
Hyväksymispäivämäärä
2020-02-17
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-202002122019
https://urn.fi/URN:NBN:fi:tuni-202002122019
Tiivistelmä
Introduction: Diabetes mellitus has been linked with adverse prostate cancer (PCa) outcomes. However, role of hyperglycemia in PCa progression is unclear. We evaluated the link between hyperglycemia and PCa survival among Finnish PCa patients.
Methods: The study cohort included 1,770 men with data on fasting glucose and diagnosed with PCa within the Finnish Randomized Study of Screening for PCa in 1995-2009. Additionally, 1,398 men had data on glycated haemoglobin (HbA1c). Information on fasting glucose and HbA1c measurements was obtained from the regional laboratory database. Antidiabetic medication use was obtained from the prescription database of the Social Insurance Institution (SII). Time-dependent Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals for PCa death among diabetic, glucose intolerant (IGT), and normoglycemic men.
Results: During median follow-up of 9.9 years after the diagnosis, 182 men died from PCa. After adjustment for tumor stage, Gleason grade and PSA level at diagnosis, diabetic fasting glucose level after PCa diagnosis was associated with elevated risk of PCa death compared to normoglycemic men (HR 1.67 95% CI 1.18-2.36). The risk association was strongest among participants with localized cancer at diagnosis; HR 2.39, 95% CI 1.45-3.93. The risk elevation was observed for glucose measurements taken up to five years earlier. Diabetic glucose levels measured before the diagnosis were not associated with PCa death.
Conclusion: Our study cohort suggests an increased risk of PCa death in men with diabetic fasting blood glucose levels, supporting the role of hyperglycemia as risk factor for PCa progression.
Methods: The study cohort included 1,770 men with data on fasting glucose and diagnosed with PCa within the Finnish Randomized Study of Screening for PCa in 1995-2009. Additionally, 1,398 men had data on glycated haemoglobin (HbA1c). Information on fasting glucose and HbA1c measurements was obtained from the regional laboratory database. Antidiabetic medication use was obtained from the prescription database of the Social Insurance Institution (SII). Time-dependent Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals for PCa death among diabetic, glucose intolerant (IGT), and normoglycemic men.
Results: During median follow-up of 9.9 years after the diagnosis, 182 men died from PCa. After adjustment for tumor stage, Gleason grade and PSA level at diagnosis, diabetic fasting glucose level after PCa diagnosis was associated with elevated risk of PCa death compared to normoglycemic men (HR 1.67 95% CI 1.18-2.36). The risk association was strongest among participants with localized cancer at diagnosis; HR 2.39, 95% CI 1.45-3.93. The risk elevation was observed for glucose measurements taken up to five years earlier. Diabetic glucose levels measured before the diagnosis were not associated with PCa death.
Conclusion: Our study cohort suggests an increased risk of PCa death in men with diabetic fasting blood glucose levels, supporting the role of hyperglycemia as risk factor for PCa progression.