Significance Of Preoperative HbA1c Level In Patients With Diabetes Mellitus And Clinically Localized Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Diabetes
Article Date: 30 Mar 2009 - 4:00 PDT

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UroToday.com - In the online version of The Prostate, a group of Korean investigators linked pre-radical prostatectomy (RP) hemoglobin A1c (HbA1c) levels in patients with type II diabetes mellitus (DM) and tumor aggressiveness. The retrospective study analyzed the records of 740 men with prostate cancer (CaP) who underwent RP for clinically localized disease. No patient received pre-operative androgen deprivation therapy or radiotherapy. They identified 89 men (12%) who had type II DM at the time of surgery. Clinical and pathologic data was abstracted and associations statistically studied.

Mean patient age was 66.2 years and mean preoperative PSA was 11.2 ng/ml. The most common pathologic Gleason score was 7 in 63.5% and stage was pT2c in 40.4%. No significant differences were found with regard to preoperative clinical or demographic factors between those with and without DM. The DM patients were further divided into 2 groups; group 1 men had HbA1c levels <6.5% and group 2 was above 6.5%. Again, no differences were noted between groups 1 and 2 regarding pre-operative variables. Post-operative factors in univariable analysis showed no difference for seminal vesicle involvement or surgical margin status. However, group 2 had a significantly higher rate of pT3a disease. Also, Gleason score increased 0.233 for every 1% increase in HbA1c. Group 2 had a significantly higher number of men with pathologic Gleason score >7 when compared to men without DM. In multivariable analysis, HbA1c levels along with PSA level and biopsy Gleason score was observed to be an independent preoperative predictor of pathologic Gleason score. PSA, biopsy Gleason score and HbA1c level were independent predictors of extraprostatic extension. However, only PSA, and not HbA1c levels, was observed to be an independent predictor of seminal vesicle involvement. Thus, glycemic control may be associated with outcomes for men with CaP undergoing radical prostatectomy.

Hong SK, Lee ST, Kim SS, Min KE, Byun SS, Cho SY, Choe G, Lee SE
Prostate. 2009 Feb 2. Epub ahead of print.
doi:10.1002/pros.20932

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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