Basaria S et al. (2006) Hyperglycemia and insulin resistance in men with prostate carcinoma who receive androgen-deprivation therapy. Cancer 106: 581–588

Men with prostate cancer often receive androgen-deprivation therapy (ADT), which renders them hypogonadal. Basaria et al. performed a cross-sectional study to see if the insulin-resistant profile associated with ADT is caused by an increased BMI— a side effect of hypogonadism—or by hypogonadism directly.

The authors compared two groups with prostate cancer: 18 hypogonadal men who had received ADT for at least 12 months and 17 men who had undergone nonchemotherapeutic treatment but not ADT. Also included were 18 age-matched controls with normal serum PSA levels. Most participants were white and none had diabetes mellitus.

The highest LEPTIN levels and BMI were seen in hypogonadal men. After adjustment for age and BMI, these men still had the highest fasting blood levels of insulin and glucose. They were more insulin-resistant than eugonadal men, and 44% had fasting glucose levels sufficient for a clinical diagnosis of diabetes mellitus. Combining all groups' data, there was a substantial negative correlation of testosterone with the metabolic parameters measured.

Insulin resistance is a risk factor for cardiovascular disease, and the authors suggest that leptin could promote the growth and survival of prostate-cancer cells. So, although ADT might be beneficial initially, its effects on insulin and leptin levels could cause the high cardiovascular mortality of patients with prostate cancer, and enhance recurrence and metastasis of the disease itself. The authors recommend hyperglycemic screening of patients on ADT and investigation into the use of insulin-sensitizing agents.