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Association of diabetes mellitus and metformin use with biochemical recurrence in patients treated with radical prostatectomy for prostate cancer

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World Journal of Urology Aims and scope

Abstract

Purpose

The impact of diabetes mellitus (DM) and metformin use on biochemical recurrence (BCR) in patients treated with radical prostatectomy (RP) remains controversial.

Methods

We retrospectively evaluated 6,863 patients who underwent RP for clinically localized PC between 2000 and 2011. Univariable and multivariable Cox regression models addressed the association of DM and metformin use with BCR.

Results

Overall, 664 patients had a diagnosis of DM from which 287 (43 %) were on metformin and 377 (57 %) were on anti-diabetics other than metformin. DM and metformin were not associated with any clinicopathologic features (p values >0.05). Within a median follow-up of 25 months (interquartile range 35 months), 774 (11.3 %) patients experienced BCR. Actuarial 5-year biochemical-free survival was 83 % for non-diabetic, 79 % for diabetic patients without metformin use, and 85 % for diabetic patients with metformin use (log rank p = 0.17). In uni- and multivariable Cox regression analyses with the non-diabetic group as referent, DM without metformin use (HR = 0.99; 95 % CI 0.75–1.30, p = 0.65) and DM with metformin use (HR = 0.84, 95 % CI 0.58–1.22, p = 0.36) were not associated with BCR after RP. A subgroup analysis stratified by nodal status, surgical margins, tumor stage, and Gleason sum did not reveal any significant association between DM, use of metformin and risk of BCR.

Conclusions

We found no association between DM or metformin use and cancer-specific features or BCR in patients treated with RP. The effect of DM and metformin on complications, wound healing and overall survival needs to be assessed in similar cohorts.

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Acknowledgments

M. Rieken acknowledges grant support by the Swiss National Science Foundation.

Conflict of interest

A Bachmann is on the advisory board of American Medical Systems and principal investigator of the GOLIATH study. S.F. Shariat is on the advisory board of Ferring Pharmaceuticals.

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Authors and Affiliations

  1. Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

    Malte Rieken, Luis A. Kluth, Evanguelos Xylinas, Michael Herman, Richard K. Lee, Talia Faison, Douglas S. Scherr, Ashutosh Tewari & Shahrokh F. Shariat

  2. Department of Urology, University Hospital Basel, Basel, Switzerland

    Malte Rieken & Alexander Bachmann

  3. Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany

    Luis A. Kluth & Andreas Becker

  4. Department of Urology Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France

    Evanguelos Xylinas

  5. Department of Urology, University of Montreal, Montreal, QC, Canada

    Andreas Becker & Pierre I. Karakiewicz

  6. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Yair Lotan

  7. Department of Urology, Krankenhaus der Barmherzigen Brüder, Wien, Austria

    Paul Schramek

  8. Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria

    Mesut Remzi

  9. Prostate Cancer Center, Krankenhaus Barmherzige Schwestern Linz, Linz, Austria

    Wolfgang Loidl

  10. Department of Urology, Medical University of Graz, Graz, Austria

    Karl Pummer

  11. Unit of Gender Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

    Alexandra Kautzky-Willer

  12. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Harun Fajkovic, Christian Seitz & Shahrokh F. Shariat

Authors
  1. Malte Rieken
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  2. Luis A. Kluth
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  3. Evanguelos Xylinas
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  4. Harun Fajkovic
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  5. Andreas Becker
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  6. Pierre I. Karakiewicz
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  7. Michael Herman
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  8. Yair Lotan
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  9. Christian Seitz
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  10. Paul Schramek
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  11. Mesut Remzi
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  12. Wolfgang Loidl
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  13. Karl Pummer
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  14. Richard K. Lee
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  15. Talia Faison
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  16. Douglas S. Scherr
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  17. Alexandra Kautzky-Willer
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  18. Alexander Bachmann
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  19. Ashutosh Tewari
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  20. Shahrokh F. Shariat
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Corresponding author

Correspondence to Shahrokh F. Shariat.

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Rieken, M., Kluth, L.A., Xylinas, E. et al. Association of diabetes mellitus and metformin use with biochemical recurrence in patients treated with radical prostatectomy for prostate cancer. World J Urol 32, 999–1005 (2014). https://doi.org/10.1007/s00345-013-1171-7

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  • DOI: https://doi.org/10.1007/s00345-013-1171-7

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