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Diabetes and Mortality in Men With Locally Advanced Prostate Cancer: RTOG 92-02

Matthew R. Smith, Kyounghwa Bae, Jason A. Efstathiou, Gerald E. Hanks, Miljenko V. Pilepich, Howard M. Sandler, William U. Shipley

From the Division of Hematology and Oncology and Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA; Department of Statistics, Radiation Therapy Oncology Group; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA; Department of Radiation Oncology, University of California, Los Angeles School of Medicine, Los Angeles, CA; and Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI

Corresponding author: Matthew R. Smith, MD, PhD, Massachusetts General Hospital Cancer Center, Yawkey 7038, 55 Fruit St, Boston, MA 02114; e-mail: smith.matthew{at}mgh.harvard.edu

Purpose Diabetes is associated with lower risk of prostate cancer. Most men with diabetes are obese, and obesity is associated with greater prostate cancer mortality. Whether diabetes influences outcomes after prostate cancer diagnosis is unknown.

Patients and Methods We assessed the relationship between prevalent diabetes and mortality using data from Radiation Therapy Oncology Group Protocol 92-02, a large randomized trial of men (N = 1,554) treated with radiation therapy and short-term versus long-term adjuvant goserelin for locally advanced prostate cancer. Regression and proportional hazard models were performed to evaluate relationships between prevalent diabetes and all-cause mortality, prostate cancer mortality, and non–prostate cancer mortality. Covariates included age, race, tumor stage, Gleason score, prostate-specific antigen, weight, and treatment arm.

Results There were a total of 765 deaths; 210 (27%) were attributed to prostate cancer. In univariate analyses, prevalent diabetes was associated with greater all-cause mortality and non–prostate cancer mortality but not prostate cancer mortality. After controlling for other covariates, prevalent diabetes remained significantly associated with greater all-cause mortality and non–prostate cancer mortality (hazard ratio [HR] = 2.12; 95% CI, 1.69 to 2.66; P < .0001) but not prostate cancer mortality (HR = 0.80; 95% CI, 0.51 to 1.25; P = .34). In contrast, weight was associated with greater prostate cancer mortality (HR = 1.77; 95% CI, 1.22 to 2.55; P = .002) but not all-cause or non–prostate cancer mortality.

Conclusion Weight but not prevalent diabetes is associated with greater prostate cancer mortality in men receiving combined modality treatment for locally advanced disease. These observations suggest that the association between obesity and greater prostate cancer mortality is mediated by mechanism(s) other than the characteristic metabolic alterations of diabetes.

Supported by Grants No. RTOG U10 CA21661, CCOP U10 CA37422, and Stat U10 CA32115 from the National Cancer Institute. M.R.S. is supported by an NIH K24 Midcareer Investigator Award (K24 CA121990) and competitive research awards from the Prostate Cancer Foundation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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				Diabetes and Mortality in Men with Prostate Cancer Journal Watch Oncology and Hematology, October 7, 2008; 2008(1007): 1 - 1. [Full Text]