A140: Androgen Deprivation Therapy and Diabetes: Effects of duration and type of treatment

Danielle Crawley1,Hans Garmo1,Sarah Rudman2,Par Stattin3,Christel Haggstrom3,Bjorn Zethelius5,Lars Holmberg1,Jan Adolfsson4,Mieke Van Hemelrijck1

1Cancer Epidemiology Group, King’s College London, London, UK,2Department of Oncology, Guy’s and St Thomas’ NHS Trust, London, UK,3Umea University, Umea, Sweden,4Karolinska University, Stockholm, Sweden,5Uppsala University, Uppsala, Sweden

Presenting date: Monday 2 November
Presenting time: 13.10-14.00

Background

 

Existing literature suggests that androgen deprivation therapy (ADT) used in the treatment of prostate cancer (PCa) raises the risk of diabetes; however the effect of different types and durations of ADT is not fully understood. Here, we have examined how type and duration of ADT affects risk of diabetes.

 

Method

 

By using data from  Prostate Cancer database Sweden (PCBaSe) we investigated risk of diabetes in a cohort of 34,031 men with PCa on ADT compared to an age-matched, PCa-free comparison cohort (n=167,205) using multivariate Cox proportional hazard regression. The outcome was a newly filed prescription for metformin, sulphonylurea or insulin. Information on different forms of ADT, including anti-androgens (AA) vs. gonadotropin-releasing hormone (GnRH) agonists and the duration of treatment, was used.

 

Results

 

Of the 34,031 men with PCa, 21,874 received GnRH agonists, 9,143 AA and 3,014 an orchidectomy.  Risk of diabetes was increased in those men on GnRH agonists for the first 3 years (1-1.5 years HR: 1.61 (95%CI:1.36-1.91); 1.5-2 years HR: 1.48 (95%CI:1.23-1.78), 2-2.5years HR: 1.68 (95%CI: 1.40-2.02); and 2.5-3 years HR: 1.42 (95CI%: 1.16-1.76), before the risk decreased (3-4 years HR: 1.17 (95% CI: 0.98-1.40); 7-10 years HR: 0.96 (95%CI: 0.77-1.19), >10 years HR: 0.69 (95%CI: 0.45-1.05)).  Conversely, no increased risk was seen in those men on AA (HR: 0.74 (95%CI: 0.65-0.84) and this was stable over time. The incidence of diabetes per 1,000 person-years was: No ADT 10.44, AA 8.05 and GnRH agonists 13.02.

 

 

 

Conclusion

 

We show that type and duration of ADT treatment has a significant impact on the risk of developing diabetes in men with PCa. Although we cannot fully exclude the possibility of allocation bias, it appears that men on GnRH agonists have an increased risk of diabetes, whilst those on AA do not.