Prevalence of Diabetes Mellitus and Metabolic Syndrome in Prostate Cancer Patients given Androgen Deprivation Therapy

  • Maria Luisa Cecilia Rivera-Arkoncel Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines- Philippine General Hospital
  • Michael Sagun Division of Urology, Department of Surgery, University of the Philippines- Philippine General Hospital
  • Francis Raymond Arkoncel Division of Urology, Department of Surgery, University of the Philippines- Philippine General Hospital
  • Cecilia Jimeno Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines- Philippine General Hospital
  • Marie Carmela Lapitan Division of Urology, Department of Surgery, University of the Philippines- Philippine General Hospital

Abstract

Objective. To compare the prevalence of diabetes mellitus (DM) and metabolic syndrome (MetS) in prostate cancer patients with or without androgen deprivation therapy (ADT).

 

Methodology. This is a cross-sectional analytic study of prostate cancer patients from the Integrated Surgical Information System database of the Philippine General Hospital from 2004-2010. Patients who received either continuous monthly GnRH agonist injection for at least 6 months or underwent bilateral orchiectomy at least 6 months prior  (ADT group) were compared to those who did not (non-ADT group). Patients with DM and MetS were identified using the American Diabetes Association Standards of Medical Care in Diabetes 2010 and IDF Definition of Metabolic Syndrome.

 

Results. The prevalence of DM in the ADT group is 42% and 19% in the non-ADT group (p = 0.0460). The probability of having DM is 2.17x higher among prostate cancer patients who received ADT compared to those who did not. The prevalence of metabolic syndrome in the ADT and non-ADT group is 37% and 28%, respectively (p=0.4620).

 

Conclusions. Prostate cancer patients have become an important emerging population of medically at risk older men. Our study showed that the prevalence of DM is significantly higher among the ADT group, with a trend towards greater prevalence of metabolic syndrome in the same group. These men may benefit from closer monitoring for the development of these metabolic complications.

Objective[JAFES1] . To compare the prevalence of diabetes mellitus (DM) and metabolic syndrome (MetS) in prostate cancer patients with or without androgen deprivation therapy (ADT).

 

Methodology[JAFES2] . This is a cross-sectional analytic study of prostate cancer patients from the Integrated Surgical Information System database of the Philippine General Hospital from 2004-2010. Patients who received either continuous monthly GnRH agonist injection for at least 6 months or underwent bilateral orchiectomy at least 6 months prior  (ADT group) were compared to those who did not (non-ADT group). Patients with DM and MetS were identified using the American Diabetes Association Standards of Medical Care in Diabetes 2010 and IDF Definition of Metabolic Syndrome.

 

Results[JAFES3] . The prevalence of DM in the ADT group is 42% and 19% in the non-ADT group (p = 0.0460). The probability of having DM is 2.17x higher among prostate cancer patients who received ADT compared to those who did not. The prevalence of metabolic syndrome in the ADT and non-ADT group is 37% and 28%, respectively (p=0.4620).

 

Conclusions[JAFES4] . Prostate cancer patients have become an important emerging population of medically at risk older men. Our study showed that the prevalence of DM is significantly higher among the ADT group, with a trend towards greater prevalence of metabolic syndrome in the same group. These men may benefit from closer monitoring for the development of these metabolic complications.

 [JAFES1]styles

 [JAFES2]styles

 [JAFES3]styles

 [JAFES4]styles

Downloads

Download data is not yet available.

References

Surveillance Epidemiology and End Results. SEER Stat Fact Sheets. Prostate Cancer. 2010 [January 1,2011]; Available from: http://seer.cancer.gov/statfacts/html/prost.html.

Hong Gee S, Christopher WSC. Changing demography of prostate cancer in Asia. European Journal of Cancer (Oxford, England : 1990). 2005;41(6):834-45.

Ngelangel CA, Wang EH. Cancer and the Philippine Cancer Control Program. Jpn J Clin Oncol. 2002 Mar;32 Suppl:S52-61.

Braga-Basaria M, Dobs AS, Muller DC, Carducci MA, John M, Egan J, et al. Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy. J Clin Oncol. 2006 Aug 20;24(24):3979-83.

Basaria S, Muller DC, Carducci MA, Egan J, Dobs AS. Hyperglycemia and insulin resistance in men with prostate carcinoma who receive androgen-deprivation therapy. Cancer. 2006 Feb 1;106(3):581-8.

Smith JC, Bennett S, Evans LM, Kynaston HG, Parmar M, Mason MD, et al. The effects of induced hypogonadism on arterial stiffness, body composition and metabolic parameters in males with prostate cancer. J Clin Endocrinol Metab. 2001 Sep;86(9):4261-7.

Lage MJ, Barber BL, Markus RA. Association between androgen-deprivation therapy and incidence of diabetes among males with prostate cancer. Urology. 2007 Dec;70(6):1104-8.

Alibhai SM, Duong-Hua M, Sutradhar R, Fleshner NE, Warde P, Cheung AM, et al. Impact of androgen deprivation therapy on cardiovascular disease and diabetes. J Clin Oncol. 2009 Jul 20;27(21):3452-8.

Basaria S, Lieb J, 2nd, Tang AM, DeWeese T, Carducci M, Eisenberger M, et al. Long-term effects of androgen deprivation therapy in prostate cancer patients. Clin Endocrinol (Oxf). 2002 Jun;56(6):779-86.

Keating NL, O'Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol. 2006 Sep 20;24(27):4448-56.

Saigal CS, Gore JL, Krupski TL, Hanley J, Schonlau M, Litwin MS. Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer. Cancer. 2007 Oct 1;110(7):1493-500.

Basaria S. Androgen deprivation therapy, insulin resistance, and cardiovascular mortality: An inconvenient truth. J Androl 2008 Sep-Oct;29(5):534-9.

Standards of medical care in diabetes--2010. Diabetes Care. Jan;33 Suppl 1:S11-61.

The International Diabetes Federation Worldwide Definition of the Metabolic Syndrome. 2006.

Saylor PJ, Smith MR. Adverse effects of androgen deprivation therapy: Defining the problem and promoting health among men with prostate cancer. J Natl Compr Canc Netw. Feb;8(2):211-23.

Tangen CM, Faulkner JR, Crawford ED, Thompson IM, Hirano D, Eisenberger M, et al. Ten-year survival in patients with metastatic prostate cancer. Clin Prostate Cancer. 2003 Jun;2(1):41-5.

Bolla M, Collette L, Blank L, Warde P, Dubois JB, Mirimanoff RO, et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): A phase III randomised trial. Lancet. 2002 Jul 13;360(9327):103-6.

D'Amico AV, Manola J, Loffredo M, Renshaw AA, DellaCroce A, Kantoff PW. 6-month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: A randomized controlled trial. JAMA. 2004 Aug 18;292(7):821-7.

Leuprolide versus diethylstilbestrol for metastatic prostate cancer. The Leuprolide Study Group. N Engl J Med. 1984 Nov 15;311(20):1281-6.

Vogelzang NJ, Chodak GW, Soloway MS, Block NL, Schellhammer PF, Smith JA, Jr., et al. Goserelin versus orchiectomy in the treatment of advanced prostate cancer: Final results of a randomized trial. Zoladex Prostate Study Group. Urology. 1995 Aug;46(2):220-6.

Walsh PC. Immediate versus deferred treatment for advanced prostatic cancer: Initial results of the Medical Research Council trial. The Medical Research Council Prostate Cancer Working Party Investigators Group. J Urol. 1997 Oct;158(4):1623-4.

Messing EM, Manola J, Yao J, Kiernan M, Crawford D, Wilding G, et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006 Jun;7(6):472-9.

Barry MJ, Delorenzo MA, Walker-Corkery ES, Lucas FL, Wennberg DC. The rising prevalence of androgen deprivation among older American men since the advent of prostate-specific antigen testing: A population-based cohort study. BJU Int. 2006 Nov;98(5):973-8.

Shahinian VB, Kuo YF, Freeman JL, Orihuela E, Goodwin JS. Increasing use of gonadotropin-releasing hormone agonists for the treatment of localized prostate carcinoma. Cancer. 2005 Apr 15;103(8):1615-24.

Muller M, Grobbee DE, den Tonkelaar I, Lamberts SW, van der Schouw YT. Endogenous sex hormones and metabolic syndrome in aging men. J Clin Endocrinol Metab. 2005 May;90(5):2618-23.

Haffner SM, Shaten J, Stern MP, Smith GD, Kuller L. Low levels of sex hormone-binding globulin and testosterone predict the development of non-insulin-dependent diabetes mellitus in men. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Am J Epidemiol. 1996 May 1;143(9):889-97.

Smith MR, Finkelstein JS, McGovern FJ, Zietman AL, Fallon MA, Schoenfeld DA, et al. Changes in body composition during androgen deprivation therapy for prostate cancer. J Clin Endocrinol Metab. 2002 Feb;87(2):599-603.

Smith MR. Changes in fat and lean body mass during androgen-deprivation therapy for prostate cancer. Urology. 2004 Apr;63(4):742-5.

Smith MR, Lee H, McGovern F, Fallon MA, Goode M, Zietman AL, et al. Metabolic changes during gonadotropin-releasing hormone agonist therapy for prostate cancer: Differences from the classic metabolic syndrome. Cancer. 2008 May 15;112(10):2188-94.

Tayek JA, Heber D, Byerley LO, Steiner B, Rajfer J, Swerdloff RS. Nutritional and metabolic effects of gonadotropin-releasing hormone agonist treatment for prostate cancer. Metabolism. 1990 Dec;39(12):1314-9.

Kim HS, Moreira DM, Smith MR, Presti JC, Jr., Aronson WJ, Terris MK, et al. A natural history of weight change in men with prostate cancer on androgen-deprivation therapy (ADT): Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int. Sep 22.

Haffner SM, Mykkanen L, Valdez RA, Katz MS. Relationship of sex hormones to lipids and lipoproteins in nondiabetic men. J Clin Endocrinol Metab. 1993 Dec;77(6):1610-5.

Malkin CJ, Pugh PJ, Jones RD, Kapoor D, Channer KS, Jones TH. The effect of testosterone replacement on endogenous inflammatory cytokines and lipid profiles in hypogonadal men. J Clin Endocrinol Metab. 2004 Jul;89(7):3313-8.

Dockery F, Bulpitt CJ, Agarwal S, Donaldson M, Rajkumar C. Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia. Clin Sci (Lond). 2003 Feb;104(2):195-201.

Eri LM, Urdal P, Bechensteen AG. Effects of the luteinizing hormone-releasing hormone agonist leuprolide on lipoproteins, fibrinogen and plasminogen activator inhibitor in patients with benign prostatic hyperplasia. J Urol. 1995 Jul;154(1):100-4.

Smith MR, Malkowicz SB, Chu F, Forrest J, Sieber P, Barnette KG, et al. Toremifene improves lipid profiles in men receiving androgen-deprivation therapy for prostate cancer: Interim analysis of a multicenter phase III study. J Clin Oncol. 2008 Apr 10;26(11):1824-9.

Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: A meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007 Dec 1;370(9602):1829-39.

Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 1986 Nov 28;256(20):2823-8.

Smith MR, Lee H, Nathan DM. Insulin sensitivity during combined androgen blockade for prostate cancer. J Clin Endocrinol Metab. 2006 Apr;91(4):1305-8.

Despres JP, Lamarche B, Mauriege P, Cantin B, Dagenais GR, Moorjani S, et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med. 1996 Apr 11;334(15):952-7.

Cockram CS. The epidemiology of diabetes mellitus in the Asia-Pacific region. Hong Kong Med J. 2000 Mar;6(1):43-52.

Laaksonen DE, Niskanen L, Punnonen K, Nyyssonen K, Tuomainen TP, Valkonen VP, et al. Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. 2004 May;27(5):1036-41.

D'Amico AV DJ, Crook J, Chen MH, Goldhaber SZ, Lamb DS, Joseph D, Tai KH, Malone S, Ludgate C, Steigler A, Kantoff PW. Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarction. J Clin Oncol. 2007;25:2420-5.

Shahani S, Braga-Basaria M, Basaria S. Androgen Deprivation Therapy in Prostate Cancer and Metabolic Risk for Atherosclerosis. J Clin Endocrinol Metab. June 1, 2008;93(6):2042-9.

Published
2014-05-31
How to Cite
Rivera-Arkoncel, M. L. C., Sagun, M., Arkoncel, F. R., Jimeno, C., & Lapitan, M. C. (2014). Prevalence of Diabetes Mellitus and Metabolic Syndrome in Prostate Cancer Patients given Androgen Deprivation Therapy. Journal of the ASEAN Federation of Endocrine Societies, 29(1), 42. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/114
Section
Original Articles