New Canadian study (some US involvement) below [1].
"2,332 diabetic men were included, with a median follow-up time of 9.4 years (interquartile range 5.4-13.4 years).
"A total of 2,036 patients (87.3%) received metformin.
"Compared to non-metformin users, metformin use was associated with decreased CaP diagnosis rate" - 31% less
... "lower hazard of undergoing an additional" prostate biopsy - 36% less
... "and receiving ADT" - 28% less.
(association doesn't prove causality, etc, etc.)
Many men diagnosed with PCa are pre-diabetic. They may remain so forever (at least until ADT), but perhaps there would be a similar association if taken before diagnosis.
Or even after, when there is insulin resistance?
-Patrick
[1] pubmed.ncbi.nlm.nih.gov/329...
Oncol
. 2020 Sep 17;S1078-1439(20)30401-4. doi: 10.1016/j.urolonc.2020.08.032. Online ahead of print.
The suggested chemopreventive association of metformin with prostate cancer in diabetic patients
Hanan Goldberg 1 , Faizan K Mohsin 2 , Alejandro Berlin 3 , Thenappan Chandrasekar 4 , Christopher J D Wallis 5 , Zachary Klaassen 6 , Ardalan E Ahmad 7 , Refik Saskin 8 , Miran Kenk 9 , Olli Saarela 2 , Girish S Kulkarni 10 , Shabbir M H Alibhai 11 , Neil Fleshner 9
Affiliations collapse
Affiliations
1 Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Urology, SUNY Upstate Medical University, Syracuse, NY; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: gohanan@gmail.com.
2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
3 Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network; Department of Radiation Oncology, University of Toronto; and Techna Institute, University Health Network, Toronto, Ontario, Canada.
4 Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia PA.
5 Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada; Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
6 Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA; Georgia Cancer Center, GA.
7 Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
8 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
9 Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
10 Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
11 Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada.
PMID: 32951988 DOI: 10.1016/j.urolonc.2020.08.032
Abstract
Purpose: Metformin, an insulin sensitizer, is the most common first-line antidiabetic therapy. There is increasing evidence suggesting metformin can prevent the emergence of prostate cancer (CaP). We aimed to analyze the chemopreventive role of metformin, in conjunction with other putative chemopreventive medications (statins, proton-pump-inhibitors, alpha-blockers, 5-alpha-reductase inhibitors, diabetic medications) in a population-based cohort study.
Methods: Data were incorporated from the Institute for Clinical and Evaluative Sciences to identify all diabetic men aged 66 and above with prior history of a negative prostate biopsy (PB) between 1994 and 2016, who were not on any of the medications prior to study inclusion. Multivariable Cox regression models with time-dependent covariates were used to assess the association of metformin to CaP diagnosis, subsequent PB, and use of androgen deprivation therapy (ADT). All models were adjusted for age, rurality, comorbidity, and year of study inclusion.
Results: Overall, 2,332 diabetic men were included, with a median follow-up time of 9.4 years (interquartile range 5.4-13.4 years). A total of 2,036 patients (87.3%) received metformin. Compared to non-metformin users, metformin use was associated with decreased CaP diagnosis rate (HR 0.69, 95%CI 0.54-0.88, P = 0.003), lower hazard of undergoing an additional PB (HR 0.64, 95%CI 0.44-0.95, P = 0.03), and receiving ADT (HR 0.72, 95%CI 0.54-0.96, P = 0.003).
Conclusion: Men receiving metformin were less likely to have suspected or diagnosed CaP, and in those with CaP, the use of ADT was less common. Ongoing prospective randomized studies will determine if these findings correspond to the suggested associations of metformin in the emergence and/or progression of CaP.
Keywords: Androgen deprivation therapy; Diabetes; Metformin; Prostate biopsy; Prostate cancer.
Copyright © 2020 Elsevier Inc. All rights reserved.
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