Alireza Aminsharifi1, Lauren E Howard2, Christopher L Amling3, William J Aronson4, Matthew R Cooperberg5, Christopher J Kane6, Martha K Terris7, Thomas J Polascik8, Stephen J Freedland9. 1. Division of Urology, Duke Cancer Institute, Durham, NC; Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: ali.amin.sharifi@duke.edu. 2. Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC. 3. Department of Urology, Oregon Health & Science University, Portland, OR. 4. Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA. 5. Departments of Urology and Epidemiology & Biostatistics, University of California, San Francisco, CA. 6. Department of Urology, University of California at San Diego Medical Center, San Diego, CA. 7. Urology Section, Department of Surgery, Veterans Affairs Medical Centers and Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA. 8. Division of Urology, Duke Cancer Institute, Durham, NC; Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC. 9. Urology Section, Department of Surgery, Veterans Affairs Medical Center, Durham, NC; Division of Urology and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Abstract
PURPOSE: To investigate the preoperative use of combination metformin and statin versus monotherapy on biochemical recurrence (BCR) after radical prostatectomy (RP) in diabetic men. PATIENTS AND METHODS: Data of 843 diabetic men who underwent RP were stratified on the basis of preoperative use of no drug or of metformin, statin, or both. Multivariable Cox models were used to test the association between treatment and BCR. In a secondary analysis, models were stratified by race and body mass index (BMI) and further adjusted for glycated hemoglobin (HbA1c). RESULTS: A total of 259 men (31%) received statin therapy, 94 (11%) metformin, 307 (36%) metformin + statin, and 183 (22%) neither. Five-year BCR-free survival rates were 75% in metformin only versus 75% in metformin + statin versus 60% in statin versus 68% in no drug groups (log-rank, P = .003). On multivariable analysis, preoperative statin use was associated with increased BCR risk versus men receiving neither drug (hazard ratio [HR] = 1.84; 95% confidence interval [CI], 1.28-2.64). Metformin alone (HR 0.88; 95% CI, 0.53-1.47) and metformin + statin (HR 0.88; 95% CI, 0.58-1.33) were unrelated to BCR risks. In secondary analysis, the association between statin use and higher BCR risk was similar regardless of race, but was stronger among men with BMI ≥ 30 kg/m2 (HR 3.12; 95% CI, 1.70-5.72). These results were largely unchanged after adjusting for HbA1c. CONCLUSION: Among diabetic men undergoing RP, preoperative statin use was associated with worse BCR risk, especially among men with a high BMI, but these associations may be mitigated by concomitant use of metformin. If validated in future findings, research is needed to understand the basis for these associations.
PURPOSE: To investigate the preoperative use of combination metformin and statin versus monotherapy on biochemical recurrence (BCR) after radical prostatectomy (RP) in diabeticmen. PATIENTS AND METHODS: Data of 843 diabeticmen who underwent RP were stratified on the basis of preoperative use of no drug or of metformin, statin, or both. Multivariable Cox models were used to test the association between treatment and BCR. In a secondary analysis, models were stratified by race and body mass index (BMI) and further adjusted for glycated hemoglobin (HbA1c). RESULTS: A total of 259 men (31%) received statin therapy, 94 (11%) metformin, 307 (36%) metformin + statin, and 183 (22%) neither. Five-year BCR-free survival rates were 75% in metformin only versus 75% in metformin + statin versus 60% in statin versus 68% in no drug groups (log-rank, P = .003). On multivariable analysis, preoperative statin use was associated with increased BCR risk versus men receiving neither drug (hazard ratio [HR] = 1.84; 95% confidence interval [CI], 1.28-2.64). Metformin alone (HR 0.88; 95% CI, 0.53-1.47) and metformin + statin (HR 0.88; 95% CI, 0.58-1.33) were unrelated to BCR risks. In secondary analysis, the association between statin use and higher BCR risk was similar regardless of race, but was stronger among men with BMI ≥ 30 kg/m2 (HR 3.12; 95% CI, 1.70-5.72). These results were largely unchanged after adjusting for HbA1c. CONCLUSION: Among diabeticmen undergoing RP, preoperative statin use was associated with worse BCR risk, especially among men with a high BMI, but these associations may be mitigated by concomitant use of metformin. If validated in future findings, research is needed to understand the basis for these associations.
Authors: Abhishek Kumar; Paul Riviere; Elaine Luterstein; Vinit Nalawade; Lucas Vitzthum; Reith R Sarkar; Alex K Bryant; John P Einck; Arno J Mundt; James D Murphy; Brent S Rose Journal: Prostate Cancer Prostatic Dis Date: 2020-02-06 Impact factor: 5.554
Authors: Xiang-Lin Tan; Jian-Yu E; Yong Lin; Timothy R Rebbeck; Shou-En Lu; Mingyi Shang; William K Kelly; Anthony D'Amico; Mark N Stein; Lanjing Zhang; Thomas L Jang; Isaac Yi Kim; Kitaw Demissie; Anna Ferrari; Grace Lu-Yao Journal: Cancer Med Date: 2020-02-08 Impact factor: 4.452