Among the more serious side effects of ADT is the increased risk of diabetes. Here are two new papers that advance our understanding of the relationship between prostate cancer and diabetes…as well as the implications of treating the diabetes itself.
The first paper, out of Japan, focuses on 230 patients on ADT. The patients were divided into those who either had pre-existing diabetes or developed it while on ADT. What the authors show is that the patients who developed diabetes while on ADT were more likely to experience their cancer progressing to the more aggressive, castrate resistant form. What this means is that ADT not only increases the risk of diabetes, but acquiring diabetes while on ADT is an unfavourable sign for managing the cancer itself.
The other paper is a small study out of Egypt, which did not look at pre-existing versus newly acquired diabetes. Rather, it asked the simple question of whether using one of the standard drugs for treating diabetes, namely metformin, significantly improved the patients’ cancer control.
The sample size was small, with only 48 and 47 patients in the metformin-treated and non-metformin control groups, respectively. The study showed an overall survival benefit to treating the diabetes with metformin, although it was not quite statistically significant. The study did show that metformin significantly helped the men on ADT keep their waist circumference from growing, which is itself a feature of metabolic syndrome. And metabolic syndrome, when it emerges for men on ADT, is a sign of increased diabetic risk.
Together these two papers provide more reasons why prostate cancer patients on ADT need to manage their lifestyle to reduce the risk of diabetes. It is not only good for avoiding the damage that diabetes can cause, but it may be good for controlling the cancer itself.
To read the full paper about newly acquired versus pre-existing diabetes, see:
https://pubmed.ncbi.nlm.nih.gov/34433857/
To read the study abstract about treating diabetes with metformin, see:
https://pubmed.ncbi.nlm.nih.gov/34428740/
Refs:
Hayashi T, Miyamoto T, Nagai N, Kawabata A. Development of diabetes mellitus following hormone therapy in prostate cancer patients is associated with early progression to castration resistance. Sci Rep. 2021 25;11(1):17157. doi: 10.1038/s41598-021-96584-1.
Aboelnaga EM, Aboelnaga MM, Elkalla HM. Metformin addition to androgen deprivation therapy effect on cancer prostate patients with type 2 diabetes. Diabetes Metab Syndr. 2021 Sep-Oct;15(5):102251. doi: 10.1016/j.dsx.2021.102251. Epub 2021 Aug 18. PMID: 34428740.