Cancer Causes & Control

, Volume 29, Issue 11, pp 1143–1150 | Cite as

The association of metformin use with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study

  • Saira KhanEmail author
  • Jianwen Cai
  • Matthew E. Nielsen
  • Melissa A. Troester
  • James L. Mohler
  • Elizabeth T. H. Fontham
  • Laura Farnan
  • Bettina F. Drake
  • Andrew F. Olshan
  • Jeannette T. Bensen
Brief report



Metformin has been associated with a reduced incidence of prostate cancer and improved prostate cancer outcomes. However, whether race modifies the association between metformin use and prostate cancer aggressiveness remains uncertain. The association between metformin use and prostate cancer aggressiveness was examined separately in Black Americans (Blacks) and White Americans (Whites).


The study population consisted of 305 Black and 195 White research participants with incident prostate cancer and self-reported diabetes from the North Carolina–Louisiana Prostate Cancer Project. High-aggressive prostate cancer was defined using a composite measure of Gleason sum, prostate-specific antigen, and clinical stage. Multivariable logistic regression was used to assess the association between metformin use and high-aggressive prostate cancer at diagnosis, separately among Whites and Blacks, with adjustment for age, screening history, site, education, insurance, and body mass index.


Metformin use was associated positively with high-aggressive prostate cancer in Blacks (OR 2.01; 95% CI 1.05, 3.83). By contrast, a weak inverse association between metformin use and high-aggressive prostate cancer was found in Whites (OR 0.80, 95% CI 0.34, 1.85).


The association between metformin use and prostate cancer aggressiveness may be modified by race.


Prostate cancer Metformin Black Americans Aggressiveness PCaP 



The North Carolina–Louisiana Prostate Cancer Project (PCaP) is carried out as a collaborative study supported by the Department of Defense contract DAMD 17-03-2-0052. The authors thank the staff, advisory committees, and research subjects participating in the PCaP study for their important contributions. Dr. Khan was supported by the National Cancer Institute Grant T32190194 (PI, Colditz) and Department of Defence Grant PC170130. Drs. Khan and Drake are supported by the Foundation for Barnes-Jewish Hospital and Siteman Cancer Center. This content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute of Health (NIH).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving animal and human participants

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Saira Khan
    • 1
    Email author
  • Jianwen Cai
    • 2
  • Matthew E. Nielsen
    • 3
    • 4
    • 5
  • Melissa A. Troester
    • 3
    • 5
  • James L. Mohler
    • 4
    • 5
    • 6
    • 7
  • Elizabeth T. H. Fontham
    • 8
  • Laura Farnan
    • 5
  • Bettina F. Drake
    • 1
  • Andrew F. Olshan
    • 3
    • 5
  • Jeannette T. Bensen
    • 3
    • 5
  1. 1.Division of Public Health Sciences, Department of SurgeryWashington University in St. Louis School of MedicineSt. LouisUSA
  2. 2.Department of Biostatistics, Gillings School of Global Public HealthUniversity of North Carolina-Chapel HillChapel HillUSA
  3. 3.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina-Chapel HillChapel HillUSA
  4. 4.Department of Urology, School of MedicineUniversity of North Carolina-Chapel HillChapel HillUSA
  5. 5.Lineberger Comprehensive Cancer Center, School of MedicineUniversity of North Carolina-Chapel HillChapel HillUSA
  6. 6.Department of UrologyRoswell Park Cancer InstituteBuffaloUSA
  7. 7.Department of UrologyUniversity of Buffalo School of Medicine and BiotechnologyBuffaloUSA
  8. 8.School of Public HealthLouisiana State University Health Science CenterNew OrleansUSA

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