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The current epidemiologic evidence suggests that men with type 2 diabetes mellitus may be at lower risk of developing prostate cancer, but little is known about its association with stage and grade of the disease. The association between self-reported diabetes mellitus at recruitment and risk of prostate cancer was examined in the European Prospective Investigation into Cancer and Nutrition (EPIC). Among 139,131 eligible men, 4,531 were diagnosed with prostate cancer over an average follow-up of 12 years. Multivariable hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models stratified by EPIC-participating center and age at recruitment, and adjusted for education, smoking status, body mass index, waist circumference, and physical activity. In a subset of men without prostate cancer, the cross-sectional association between circulating concentrations of androgens and insulin-like growth factor proteins with diabetes status was also investigated using linear regression models. Compared to men with no diabetes, men with diabetes had a 26% lower risk of prostate cancer (HR, 0.74; 95% CI, 0.63-0.86). There was no evidence that the association differed by stage (p-heterogeneity, 0.19) or grade (p-heterogeneity, 0.48) of the disease, although the numbers were small in some disease subgroups. In a subset of 626 men with hormone measurements, circulating concentrations of androstenedione, total testosterone and insulin-like growth factor binding protein-three were lower in men with diabetes compared to men without diabetes. This large European study has confirmed an inverse association between self-reported diabetes mellitus and subsequent risk of prostate cancer.

Original publication

DOI

10.1002/ijc.28989

Type

Journal article

Journal

International journal of cancer

Publication Date

01/2015

Volume

136

Pages

372 - 381

Addresses

Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.

Keywords

Humans, Prostatic Neoplasms, Diabetes Mellitus, Type 2, Testosterone, Insulin-Like Growth Factor Binding Proteins, Androgens, Neoplasm Staging, Body Mass Index, Prognosis, Incidence, Risk Factors, Follow-Up Studies, Prospective Studies, Nutritional Status, Adult, Aged, Middle Aged, Europe, Male, Neoplasm Grading