Reported by Reuters, Feb 9,

By Megan Rauscher

NEW YORK (Reuters Health) - Men with recurrent or advanced prostate
cancer may be put on hormone therapy to block testosterone production in
an effort to halt or slow the growth of the tumor. However, new research
shows, this may put them at increased risk for developing insulin
resistance and elevated blood sugar levels, which can affect heart
health.
These complications of what doctors call androgen-deprivation therapy or
ADT may contribute to the high rate of heart disease in men with
prostate cancer, Baltimore-based investigators report in the journal
Cancer.

Roughly half of men who develop prostate cancer die of other, unrelated
causes, explain Dr. Shehzad Basaria from Johns Hopkins University and
colleagues. Heart disease is one of the most common causes of death in
men with prostate cancer.

In a study of 53 men with prostate cancer, the researchers found that
those treated with testosterone-lowering ADT for at least one year were
more resistant to the action of insulin - the body's key
sugar-regulating hormone - and had higher glucose levels than men who
had only received local surgery and/or radiation and had normal
testosterone levels, and age-matched healthy men with normal
testosterone levels.

According to the study, 44 percent of men in the ADT group had blood
sugar levels greater than 126, which is among the criteria for the
diagnosis of diabetes. In contrast, only about 12 percent of men in the
other groups had blood sugar levels this high.

In an e-mail to Reuters Health, Basaria said: "If these observations are
confirmed in long-term prospective studies, then insulin resistance and
diabetes should be regarded as additional side effects of androgen
deprivation in these men."

In the meantime, the investigators think men with prostate cancer who
have received ADT for at least one year should be screened for high
blood sugar.
More study, they add, is needed to determine the value of anti-diabetes
drugs in men with prostate cancer.

Source at Reuters Health
Journal source: Cancer, February 1, 2006.
Article abstract:
Hyperglycemia and insulin resistance in men with prostate carcinoma who
receive androgen-deprivation therapy.
Basaria S, Muller DC, Carducci MA, Egan J, Dobs AS.
Department of Medicine, Division of Endocrinology and Metabolism, Johns
Hopkins University School of Medicine, Baltimore, Maryland.

BACKGROUND: Prostate carcinoma (PCa) is one of the most common
malignancies in men.

Androgen-deprivation therapy (ADT) is used frequently in the treatment
of recurrent and metastatic PCa, rendering these men hypogonadal.
Because male hypogonadism is associated with an unfavorable metabolic
profile, and men with PCa have high cardiovascular mortality, the
authors evaluated the effects of long-term ADT on fasting glucose
levels, insulin levels, and insulin resistance.

METHODS: To evaluate the long-term effects of ADT on fasting glucose and
insulin resistance in men with PCa who received ADT and to determine
whether these metabolic alterations are a result of hypogonadism, the
authors conducted a cross-sectional study at a university-based research
institution in the United States. In total, 53 men were evaluated,
including 18 men with PCa who received ADT for at least 12 months prior
to the onset of the study (the ADT group), 17 age-matched men with
nonmetastatic PCa who had undergone prostatectomy and/or received
radiotherapy and who were not receiving ADT (the non-ADT group), and 18
age-matched controls (the control group). None of the men had a known
history of diabetes mellitus.

RESULTS: The mean age was similar in all 3 groups (P = 0.33). Serum
total testosterone levels (P < 0.0001) and free testosterone levels (P <
0.0001) were significantly lower in the ADT group compared with the
other groups. Men in the ADT group had a higher BMI compared with the
other groups (overall P = 0.005). After adjustment for age and BMI, men
in the ADT group had significantly higher fasting levels of the
following parameters: 1) Glucose levels were 131.0 +/- 7.43 mg/dL in the
ADT group compared with 103.0 +/- 7.42 mg/dL in the non-ADT group (P =
0.01) and 99.0 +/- 7.58 mg/dL in the control group (P < 0.01). 2)
Insulin levels were 45.0 +/- 7.25 uU/mL in the ADT group compared with
24.0 +/- 7.24 uU/mL in the non-ADT group (P = 0.05) and 19.0 +/- 7.39
uU/mL in the control group (P = 0.02). 3) Leptin levels were 25.0 +/-
2.57 ng/mL in the ADT group compared with 12.0 +/- 2.56 ng/mL in the
non-ADT group (P < 0.01) and 6.0 +/- 2.62 ng/mL in the control group (P
< 0.01). 4) The homeostatic model assessment for insulin resistance
(HOMA(IR)) = 17.0 +/- 2.78 in the ADT group compared with HOMA(IR) = 6.0
+/- 2.77 in the non-ADT group (P < 0.01) and HOMA(IR) = 5.0 +/- 2.83 in
the control group (P = 0.01). There was a significant negative
correlation between total and free testosterone levels with fasting
glucose, insulin, leptin, and HOMA(IR).

CONCLUSIONS: The current data suggested that men with PCa who are
receiving long-term ADT are at risk for developing insulin resistance
and hyperglycemia, thus leading to their increased risk of
cardiovascular disease.

This adverse metabolic profile developed independent of age and BMI and
appeared to be a direct result of androgen deprivation.


knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
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