Examining the relationship between diabetes and prostate cancer through changes in screening guidelines
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ORIGINAL PAPER
Examining the relationship between diabetes and prostate cancer through changes in screening guidelines Eric A. Miller1 · Paul F. Pinsky1 Received: 6 April 2020 / Accepted: 16 September 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose Previous studies have found that men with diabetes are at reduced risk of prostate cancer compared to men without diabetes. The lower risk could be due to biologic differences and/or a diagnosis bias from use of the prostate-specific antigen (PSA) test as a screening and diagnostic tool. We sought to further examine the relationship between diabetes and incidence of prostate cancer and examine the potential impact of changes in PSA screening guidelines in 2008 and 2012. Methods We used 2004–2015 Surveillance, Epidemiology and End Results (SEER)-Medicare data and limited the study population to men aged 67–74 with at least 2 years of continuous enrollment. Using the 5% Medicare sample as the denominator and prostate cancer cases as the numerator, we calculated age-adjusted rate ratios (RR) in 2006–2011 and 2012–2015 by diabetes status, overall and by tumor grade. We used multivariable logistic regression to compare tumor characteristics by diabetes status. Results Men with diabetes had lower incidence rates of prostate cancer compared to men without diabetes in 2006–2011 [RR = 0.89 95% confidence interval (CI) 0.87–0.91] and 2012–2015 (RR = 0.92 95% CI 0.89–0.95) but the slight attenuation toward the null in 2012–2015 was primarily due to the change in RRs for low-grade tumors. Conclusion We found differences in the risk and characteristics of prostate cancer by diabetes status and that some risks have changed over time as guidelines have changed. With lower PSA use in the more recent time-period, rates of low-grade tumors have become more similar by diabetes status. Keywords Prostate cancer screening · Diabetes · Prostate-specific antigen · Population-based
Background Previous studies have consistently found lower prostate cancer incidence rates among men with diabetes compared to men without [1–9]. The lower rates appear to be limited to low and intermediate-grade tumors, with less evidence of lower rates of high-grade tumors. Men with diabetes have been found to have lower levels of prostate-specific antigen (PSA) [10, 11], which could be an indicator of a biological and/or a detection bias between men with and without Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10552-020-01347-4) contains supplementary material, which is available to authorized users. * Eric A. Miller [email protected] 1
Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
diabetes. For example, men with diabetes have been found to have lower androgen levels, such as testosterone, that could possibly slow or inhibit tumor growth [11–13]. It has also been suggested that lower PSA levels could contribute to lower rates from a detection bias due to the use of PSA t
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