Abstract
Background
Diabetes may be associated with decreased prostate cancer (PCa) risk. However, previous studies have not always accounted for time since diabetes diagnosis or antidiabetic drug use. Futhermore, the role of metabolic syndrome (MetS) in PCa risk is still debated. We investigated the role of diabetes and MetS in PCa risk based on data from the Epidemiological study of PCa (EPICAP).
Methods
EPICAP is a population-based case-control study that included 819 incident PCa cases in 2012–2013 and 879 controls frequency matched by age. MetS was characterized according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). Logistic regression models adjusted for age, family history of PCa and ethnicity, were used to assess odds ratios (ORs) and their 95%conficence intervals (CIs) for the associations between diabetes, MetS and PCa risk.
Results
Whereas we did not observed an association between diabetes and PCa, a decreased risk of PCa has been highlighted with an increasing treated diabetes duration (p-trend=0.008). No association has been observed between MetS, the number of MetS criteria and the risk of PCa. However, we suggested that NSAIDs use could modify the association between MetS and PCa risk.
Conclusion
Our results suggest an inverse association between the duration of diabetes and PCa risk. The role of metabolic factors, such as MetS and its components, in PCa risk remains unclear and requires further investigations.
1. Background
Prostate cancer (PCa) is the most common cancer in men in industrialized countries with more than 1,4 million men diagnosed with PCa in 2020 worldwide . In France, more than 65,000 PCa cases were estimated in 2020, with 9000 deaths which represents the third cause of cancer-related mortality . Age, ethnic origin, and family history of PCa are well-established risk factors for prostate cancer. Apart from these factors, the etiology of prostate cancer remains largely unknown, however other factors have been suspected to play a role in the occurrence of this cancer such as genetic, hormonal, lifestyle and environmental factors, including occupational factors . Among lifestyle factors, an interesting area of research concerns factors related to chronic inflammation, including obesity, diabetes and metabolic syndrome (MetS).
Diabetes and MetS are both associated with increased risk of overall cancer . The relationship between diabetes and PCa has been extensively studied. The majority of the litterature suggested an inverse association with overall PCa, as shown in recent meta-analyses , and inconsistent results have been reported with aggressive PCa . MetS is a group of metabolic disorders that is used to identify individuals with higher risk of cardiovascular disease or diabetes. Several definitions have been proposed , but all include glucose intolerance, abdominal obesity, hypertension and dyslipidemia, defined as high triglycerides or low high-density lipoprotein (HDL)-cholesterol blood levels. Among these definitions, the most frequent in epidemiological studies is the National Cholesterol Education Program Adult Treatment Panel III definition . Some studies have explored the association between the different definitions of MetS and PCa and have reported conflicting results . Out of these studies, three were able to distinguish the aggressiveness of PCa showing inconsistent results between MetS and aggressive PCa .
In that context, we aimed to study the role of diabetes and MetS in PCa risk, using data from the Epidemiological study of PCa (EPICAP).
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