Diabetes and the risk of death in men with favorable or high-risk prostate cancer following radiation therapy
5157 Background: An increased risk of all cause mortality (ACM) has been observed in patients with cancer who have diabetes mellitus (DM) (JAMA 2008:300:2754–2764). Yet, how a diagnosis of DM affects survival across the risk-strata of men with prostate cancer (PC) remains unknown. Methods: The study cohort comprised 7041 men of median age 69.6 years treated with brachytherapy with or without external beam radiation therapy (RT) between 10/97 and 7/07. Short course neoadjuvant hormonal therapy (HT) was used in men with pubic arch interference in order to make them eligible for brachytherapy. Cox regression multivariable analyses were performed in men with Gleason score 8 to 10 disease and also in men with favorable-risk (low or intermediate) disease to assess whether men with DM were at increased risk for ACM compared to men without DM. The hazard ratios (HR) and 95% Confidence intervals (CI) reported were adjusted for age, extent of RT, history of myocardial infarction (MI), use of HT and known PC prognostic factors. Estimates of PC-specific mortality (PCSM) were estimated using a cumulative incidence method. Results: After a median follow-up of 4.1 years, 544 (8%) men had died. In the 466 men with Gleason score 8 to 10 cancers 31% (22/70) of deaths were from PC and a diagnosis of DM was not associated with an increased risk of ACM (Adjusted HR (AHR): 1.1 [95% CI: 0.6 to 2.2]; p = 0.78). However, as shown in the Table , for the 6575 men with favorable-risk disease where only 10% (49/474) of deaths were from PC, there was an increased risk of ACM (AHR: 1.5 [95% CI: 1.2 to 2.0]; p < 0.001) in men with diabetes as compared to those without diabetes. PCSM estimates were significantly higher (p < 0.001) in men with Gleason 8 to 10 as compared to low or intermediate-risk PC reaching 10% and 1% respectively by 7 years. Conclusions: These data highlight the importance of aggressive management of DM in men with favorable-risk PC where death from PC is unlikely. [Table: see text] No significant financial relationships to disclose.