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Blood glucose, glucose balance, and disease-specific survival after prostate cancer diagnosis in the Finnish Randomized Study of Screening for Prostate Cancer

Prostate Cancer and Prostatic Diseases volume 22, pages 453–460 (2019)Cite this article

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Abstract

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 1770 men with data on fasting glucose and diagnosed with PCa within the Finnish Randomized Study of Screening for PCa in 1995–2009. Additionally, 1398 men had data on glycated hemoglobin (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, impaired glucose tolerant, 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 5 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 a risk factor for PCa progression.

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Author notes

  1. These authors contributed equally: Teemu J. Murtola, Samueli M. Sälli

Authors and Affiliations

  1. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland

    Teemu J. Murtola, Samueli M. Sälli & Teuvo L. J. Tammela

  2. Department of Urology, Tampere University Hospital, Tampere, Finland

    Teemu J. Murtola & Teuvo L. J. Tammela

  3. Finnish Cancer Registry, Helsinki, Finland

    Kirsi Talala

  4. Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

    Kimmo Taari

  5. Faculty of Social Sciences, Tampere University, Tampere, Finland

    Anssi Auvinen

Authors
  1. Teemu J. Murtola
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  2. Samueli M. Sälli
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  3. Kirsi Talala
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  4. Kimmo Taari
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  5. Teuvo L. J. Tammela
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  6. Anssi Auvinen
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Corresponding author

Correspondence to Teemu J. Murtola.

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Conflict of interest

TJM: lecture fees from Astellas, Janssen, and MSD and paid consultant for Astellas and Jansen. KT: lecture fee from GSK, consultant fee from Abbvie, research funding from Medivation, and congress travel support from Astellas and Orion. TLJT: paid consultant for Astellas, GSK, Pfizer, Orion Pharma, and Amgen. AA: lecture fee from MSD and paid consultant for Epid Research. The other authors declare that they have no conflict of interest.

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Murtola, T.J., Sälli, S.M., Talala, K. et al. Blood glucose, glucose balance, and disease-specific survival after prostate cancer diagnosis in the Finnish Randomized Study of Screening for Prostate Cancer. Prostate Cancer Prostatic Dis 22, 453–460 (2019). https://doi.org/10.1038/s41391-018-0123-0

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