Cancer Causes & Control

, 22:977 | Cite as

The association of diabetes mellitus and high-grade prostate cancer in a multiethnic biopsy series

  • Daniel M. MoreiraEmail author
  • Tiffany Anderson
  • Leah Gerber
  • Jean-Alfred Thomas
  • Lionel L. Bañez
  • Madeline G. McKeever
  • Cathrine Hoyo
  • Delores Grant
  • Jayakrishnan Jayachandran
  • Stephen J. Freedland
Original paper



To analyze the association of diabetes mellitus (DM) with risk of prostate cancer and cancer grade among men undergoing prostate biopsy and to analyze how obesity and race modify these associations.

Materials and methods

Retrospective analysis of 998 men from the Durham VA undergoing first prostate biopsy between 2001 and 2009 with complete data available. History of DM was determined by chart review. Patients’ characteristics at biopsy were analyzed with chi-square and ranksum. Multivariable analyses of DM and risk of cancer and cancer grade were done using logistic regression adjusting for PSA, body mass index, race, age, year, and digital rectal exam.


At biopsy, 284 (28%) men had DM. DM was associated with African American (AAM; p = 0.010) and higher BMI (p < 0.001). DM was not associated with prostate cancer risk on either bivariate (p = 0.600) or multivariate analysis (p = 0.485). Similar results were found after stratification by race and obesity. In multivariable analysis, DM was associated with greater risk of high-grade disease (RR = 2.13, p = 0.024). The association was stronger among obese men (RR = 3.84, p = 0.020) and null in non-obese subjects (RR = 1.39, p = 0.460). After further stratification by race, DM was associated with high-grade disease only in obese Caucasian men (CM; RR = 5.81, p = 0.025) but not in obese AAM. DM was not associated with risk of low-grade disease in all men together or after stratification by obesity or race.


History of DM was associated with greater risk of high-grade disease. The association was strongest among obese CM suggesting the effect of DM on high-grade prostate cancer is modified by race and obesity.


Prostatic neoplasm Prostate-specific antigen Diabetes Mellitus Incidence Epidemiology Case–control studies Obesity Population groups Ethnic groups Continental population groups Male 



This study is supported by Department of Defense, Prostate Cancer Research Program (DMM, LLB, SJF), and the American Urological Association Foundation/Astellas Rising Star in Urology Award (SJF).


  1. 1.
    Kasper JS, Giovannucci E (2006) A meta-analysis of diabetes mellitus and the risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 15:2056–2062PubMedCrossRefGoogle Scholar
  2. 2.
    Gong Z, Neuhouser ML, Goodman PJ et al (2006) Obesity, diabetes, and risk of prostate cancer: results from the prostate cancer prevention trial. Cancer Epidemiol Biomarkers Prev 15:1977–1983PubMedCrossRefGoogle Scholar
  3. 3.
    Jayachandran J, Aronson WJ, Terris MK et al (2010) Diabetes and outcomes after radical prostatectomy: are results affected by obesity and race? Results from the shared equal-access regional cancer hospital database. Cancer Epidemiol Biomarkers Prev 19:9–17PubMedCrossRefGoogle Scholar
  4. 4.
    Rosenberg DJ, Neugut AI, Ahsan H, Shea S (2002) Diabetes mellitus and the risk of prostate cancer. Cancer Invest 20:157–165PubMedCrossRefGoogle Scholar
  5. 5.
    Coker AL, Sanderson M, Zheng W, Fadden MK (2004) Diabetes mellitus and prostate cancer risk among older men: population-based case–control study. Br J Cancer 90:2171–2175PubMedGoogle Scholar
  6. 6.
    Waters KM, Henderson BE, Stram DO, Wan P, Kolonel LN, Haiman CA (2009) Association of diabetes with prostate cancer risk in the multiethnic cohort. Am J Epidemiol 169:937–945PubMedCrossRefGoogle Scholar
  7. 7.
    Calton BA, Chang SC, Wright ME et al (2007) History of diabetes mellitus and subsequent prostate cancer risk in the NIH-AARP Diet and Health Study. Cancer Causes Control 18:493–503PubMedCrossRefGoogle Scholar
  8. 8.
    Coughlin SS, Neaton JD, Sengupta A (1996) Cigarette smoking as a predictor of death from prostate cancer in 348, 874 men screened for the Multiple Risk Factor Intervention Trial. Am J Epidemiol 143:1002–1006PubMedGoogle Scholar
  9. 9.
    Steenland K, Nowlin S, Palu S (1995) Cancer incidence in the National Health and Nutrition Survey I. Follow-up data: diabetes, cholesterol, pulse and physical activity. Cancer Epidemiol Biomarkers Prev 4:807–811PubMedGoogle Scholar
  10. 10.
    Bonovas S, Filioussi K, Tsantes A (2004) Diabetes mellitus and risk of prostate cancer: a meta-analysis. Diabetologia 47:1071–1078PubMedCrossRefGoogle Scholar
  11. 11.
    Kasper JS, Liu Y, Giovannucci E (2009) Diabetes mellitus and risk of prostate cancer in the health professionals follow-up study. Int J Cancer 124:1398–1403PubMedCrossRefGoogle Scholar
  12. 12.
    Muller H, Raum E, Rothenbacher D, Stegmaier C, Brenner H (2009) Association of diabetes and body mass index with levels of prostate-specific antigen: implications for correction of prostate-specific antigen cutoff values? Cancer Epidemiol Biomarkers Prev 18:1350–1356PubMedCrossRefGoogle Scholar
  13. 13.
    Leitzmann MF, Ahn J, Albanes D et al (2008) Diabetes mellitus and prostate cancer risk in the Prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Causes Control 19:1267–1276PubMedCrossRefGoogle Scholar
  14. 14.
    Chan JM, Latini DM, Cowan J, Duchane J, Carroll PR (2005) History of diabetes, clinical features of prostate cancer, and prostate cancer recurrence-data from CaPSURE (United States). Cancer Causes Control 16:789–797PubMedCrossRefGoogle Scholar
  15. 15.
    Peehl DM, Cohen P, Rosenfeld RG (1995) The insulin-like growth factor system in the prostate. World J Urol 13:306–311PubMedGoogle Scholar
  16. 16.
    Ma J, Li H, Giovannucci E et al (2008) Prediagnostic body-mass index, plasma C-peptide concentration, and prostate cancer-specific mortality in men with prostate cancer: a long-term survival analysis. Lancet Oncol 9:1039–1047PubMedCrossRefGoogle Scholar
  17. 17.
    Mantzoros CS, Tzonou A, Signorello LB, Stampfer M, Trichopoulos D, Adami HO (1997) Insulin-like growth factor 1 in relation to prostate cancer and benign prostatic hyperplasia. Br J Cancer 76:1115–1118PubMedCrossRefGoogle Scholar
  18. 18.
    Schatzl G, Madersbacher S, Thurridl T et al (2001) High-grade prostate cancer is associated with low serum testosterone levels. Prostate 47:52–58PubMedCrossRefGoogle Scholar
  19. 19.
    Antonelli JA, Jones LW, Banez LL et al (2009) Exercise and prostate cancer risk in a cohort of veterans undergoing prostate needle biopsy. J Urol 182:2226–2231PubMedCrossRefGoogle Scholar
  20. 20.
    Antonelli J, Freedland SJ, Jones LW (2009) Exercise therapy across the prostate cancer continuum. Prostate Cancer Prostatic Dis 12:110–115PubMedCrossRefGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention (2008) National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007.
  22. 22.
    Freedland SJ, Aronson WJ, Kane CJ et al (2004) Impact of obesity on biochemical control after radical prostatectomy for clinically localized prostate cancer: a report by the Shared Equal Access Regional Cancer Hospital database study group. J Clin Oncol 22:446–453PubMedCrossRefGoogle Scholar
  23. 23.
    Freedland SJ, Banez LL, Sun LL, Fitzsimons NJ, Moul JW (2009) Obese men have higher-grade and larger tumors: an analysis of the duke prostate center database. Prostate Cancer Prostatic Dis 12:259–263PubMedCrossRefGoogle Scholar
  24. 24.
    Henderson KD, Goran MI, Kolonel LN, Henderson BE, Le Marchand L (2006) Ethnic disparity in the relationship between obesity and plasma insulin-like growth factors: the multiethnic cohort. Cancer Epidemiol Biomarkers Prev 15:2298–2302PubMedCrossRefGoogle Scholar
  25. 25.
    Winters SJ, Brufsky A, Weissfeld J, Trump DL, Dyky MA, Hadeed V (2001) Testosterone, sex hormone-binding globulin, and body composition in young adult African American and Caucasian men. Metabolism 50:1242–1247PubMedCrossRefGoogle Scholar
  26. 26.
    Abdollah F, Briganti A, Suardi N, Gallina A, Capitanio U, Salonia A, Cestari A, Guazzoni G, Rigatti P, Montorsi F (2010) Does diabetes mellitus increase the risk of high-grade prostate cancer in patients undergoing radical prostatectomy? Prostate Cancer Prostatic Dis 41:74–78Google Scholar
  27. 27.
    Miller DR, Safford MM, Pogach LM (2004) Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data. Diabetes Care 27(Suppl 2):B10PubMedCrossRefGoogle Scholar
  28. 28.
    Albertsen PC, Hanley JA, Barrows GH, Penson DF, Kowalczyk PD, Sanders MM, Fine J (2005) Prostate cancer and the Will Rogers phenomenon. J Natl Cancer Inst 97:1248–1253PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. (outside the USA) 2011

Authors and Affiliations

  • Daniel M. Moreira
    • 1
    • 2
    • 6
    Email author
  • Tiffany Anderson
    • 1
  • Leah Gerber
    • 1
    • 2
  • Jean-Alfred Thomas
    • 1
    • 2
  • Lionel L. Bañez
    • 1
    • 2
  • Madeline G. McKeever
    • 1
    • 2
  • Cathrine Hoyo
    • 4
  • Delores Grant
    • 5
  • Jayakrishnan Jayachandran
    • 1
    • 2
  • Stephen J. Freedland
    • 1
    • 2
    • 3
  1. 1.Division of Urologic Surgery, Department of Surgery and the Duke Prostate CenterDuke University School of MedicineDurhamUSA
  2. 2.Urology Section, Veterans Affairs Medical Center DurhamDurhamUSA
  3. 3.Department of PathologyDuke University School of MedicineDurhamUSA
  4. 4.Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  5. 5.JLC-Biomedical/Biotechnology Research Institute, Cancer Research ProgramNorth Carolina Central UniversityDurhamUSA
  6. 6.Division of UrologyDUMC, Duke University School of MedicineDurhamUSA

Personalised recommendations