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Clinical Research

Metformin does not affect risk of biochemical recurrence following radical prostatectomy: results from the SEARCH database

Prostate Cancer and Prostatic Diseases volume 16, pages 391–397 (2013)Cite this article

Subjects

Abstract

Background:

While epidemiologic studies suggest that metformin use among diabetics may decrease prostate cancer (PC) incidence, the effect of metformin use on PC outcome is unclear. We investigated the association between pre-operative metformin use, dose and duration of use and biochemical recurrence (BCR) in PC patients with diabetes who underwent radical prostatectomy (RP).

Methods:

We conducted a retrospective cohort analysis within the Shared Equal Access Regional Cancer Hospital (SEARCH) database of 371 PC patients with diabetes who underwent RP. Time to BCR between metformin users and non-users, and by metformin dose and duration of use was assessed using multivariable Cox proportional analysis adjusted for demographic, clinical and/or pathologic features. Time to castrate-resistant PC (CRPC), metastases and PC-specific mortality were explored as secondary outcomes using unadjusted analyses.

Results:

Of 371 diabetic men, 156 (42%) were using metformin before RP. Metformin use was associated with more recent year of surgery (P<0.0001) but no clinical or pathologic characteristics. After adjustment for year of surgery, clinical and pathologic features, there were no associations between metformin use (hazard ratio (HR) 0.93; 95% confidence interval (CI) 0.61–1.41), high metformin dose (HR 0.96; 95% CI 0.57–1.61) or duration of use (HR 1.00; 95% CI 0.99–1.02) and time to BCR. A total of 14 patients (3.8%) developed CRPC, 10 (2.7%) distant metastases and 8 (2.2%) died from PC. Unadjusted analysis suggested that high metformin dose vs non-use was associated with increased risk of CRPC (HR 5.1; 95% CI 1.6–16.5), metastases (HR 4.8; 95% CI 1.2–18.5) and PC-specific mortality (HR 5.0; 95% CI 1.1–22.5).

Conclusions:

Metformin use, dose or duration of use was not associated with BCR in this cohort of diabetic PC patients treated with RP. The suggestion that higher metformin dose was associated with increased risk of CRPC, metastases and PC-specific mortality merits testing in large prospective studies with longer follow-up.

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Acknowledgements

This study was supported by EHA: NCI 5R25-CA126938-03; SJF: NIH Grant 1-R01-CA131235-01A1 and NIH 1K24CA160653.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA

    E H Allott, M R Abern, L Gerber, C J Keto & S J Freedland

  2. Cancer Prevention, Detection and Control Program, Duke Cancer Institute, Durham, NC, USA

    E H Allott

  3. Section of Urology, Veterans Affairs Medical Center, Durham, NC, USA

    E H Allott & S J Freedland

  4. Department of Surgery, Urology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    W J Aronson

  5. Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA

    W J Aronson

  6. Section of Urology, Veterans Affairs Medical Center, Augusta, GA, USA

    M K Terris

  7. Section of Urology, Medical College of Georgia, Augusta, GA, USA

    M K Terris

  8. Department of Urology, University of California, San Diego, San Diego, CA, USA

    C J Kane

  9. Division of Urology, Oregon Health Sciences University, Portland, OR, USA

    C L Amling

  10. Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA

    M R Cooperberg

  11. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA

    P G Moorman

  12. Department of Pathology, Duke University School of Medicine, Durham, NC, USA

    S J Freedland

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  1. E H Allott
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Correspondence to S J Freedland.

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Allott, E., Abern, M., Gerber, L. et al. Metformin does not affect risk of biochemical recurrence following radical prostatectomy: results from the SEARCH database. Prostate Cancer Prostatic Dis 16, 391–397 (2013). https://doi.org/10.1038/pcan.2013.48

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  • DOI: https://doi.org/10.1038/pcan.2013.48

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