Diabetes And Prostate Cancer Treatment

Diabetes As A Side Effect Of Cancer Treatment: 8 Things To Know

Diabetes affects roughly 10% of people in the United States. Another 1 in 3 has pre-diabetes, or elevated blood sugar levels that dont quite reach the threshold for diabetes.

Often, diabetes develops on its own. But sometimes it can stem from an underlying cancer or even be a side effect of the therapies used to treat it. When diabetes is caused by something else, its known as secondary diabetes.

We checked in with diabetes specialist Sonali Thosani, M.D., to learn about this potential side effect of cancer treatment, and what if anything can be done to reverse it.

How common is it for cancer patients to develop secondary diabetes as a result of their treatment or its side effects?

Thats hard to say, for a few reasons. The first is that a lot of patients come to MD Anderson with undiagnosed diabetes. That means they already have it, but they dont know it yet, because in some cases they havent been to see a doctor in years.

Another reason is that not every patient gets their blood sugar levels checked right away. Sometimes, the first evaluation of that happens before they go into surgery, or after theyve already started cancer treatment.

Many of our patients are also receiving steroids to improve their ability to tolerate chemotherapy, and high blood sugar is a known side effect of steroids. So, its challenging sometimes to distinguish between the patients who already had diabetes before they came to MD Anderson and the ones who developed it after they arrived.

Questions To Ask Your Health Care Team

• Could the recommended cancer treatment affect my blood sugar levels?

• Why is it important to continue managing diabetes during my cancer treatment?

• How often should I check my blood sugar during cancer treatment? What is the best way to do so?

• Where can I get a blood sugar monitor or other diabetes management equipment I need?

• Will I need to change the diabetes medication I take during treatment or add new medications?

• Can you recommend a Certified Diabetes Care and Education Specialist to help me adjust to changes in my diabetes care?

• What dose of my diabetes medication do I need to take? How often?

• What should my blood sugar target be before, during, and after each cancer treatment?

• What are the symptoms of high blood sugar and low blood sugar?

• What should I do if my blood sugar is too high or too low?

• Can cancer tests or scans affect my blood sugar? If so, how I manage it when I am having those specific tests?

• Does diabetes increase the risk of my cancer coming back?

Diabetes And Risk For Prostate Cancer

There have long been suggestions that men already diagnosed with and receiving treatment for diabetes are at lower risk for a subsequent diagnosis of prostate cancer than non-diabetics. However, a very large, new, epidemiological analysis seems to suggest strongly that this may not be the case at all.

Beckman et al. conducted a careful analysis of data from > 500,000 men listed in the Stockhom PSA and Biopsy Register who were living in Stockholm, Sweden, between January 1, 2006, and December 31, 2015.

The research team sought to explore the associations between the use of anti-diabetic medications and four other prostate cancer-related factors:

• Patients PSA levels
• Receipt of a biopsy following elevated PSA results
• Prostate cancer detection at biopsy

The total number of men eligible for inclusion in this study was 564,666, and their average age was 65 years.

Of these 500,000+ men,

• 4,583 were diabetics initially exposed to metformin
• 1.104 were diabetics exposed to sulfonylurea
• 978 were diabetics exposed to insulin

These men were then all age-matched to men who had had no exposure to anti-diabetic medications.

Here are the core study findings:

Beckman et al., conclude that

In other words, men with diabetes are less likely to ever get a biopsy for risk of prostate cancer than men without diabetes. And this can in and of itself explain why it seems as though men with diabetes are at lower risk for a diagnosis of prostate cancer than non-diabetic men.

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Outcome And Exposure Ascertainment

Follow-up for prostate cancer was started 2 years after diabetes diagnosis. We refer to this starting point as the index date. The motivation was 1) to avoid risk of immortal time bias from having multiple criteria for diabetes diagnosis and 2) to avoid ascertainment bias or surveillance bias .

Information on cancer diagnoses was obtained through linkage to the Israel Cancer Registry, as noted above. The prostate cancer outcome was identified by International Classification of Diseases for Oncology, Third Edition, anatomical code C61.9 and a morphology code ending in 3. The outcome date was the date of the first prostate cancer diagnosis in the registry. Individuals were followed up from their index date until the date of a prostate cancer diagnosis, death, their 90th birthday, or December 31, 2012, whichever occurred first.

Metformin exposure was defined as the purchase of a prescription for metformin, either in single pill form or as a combination pill with a dipeptidyl peptidase-4 inhibitor, although the combination form was used only from 2009 onward and comprised only 1% of all metformin purchases. We placed no restrictions on how many other glucose-lowering medications were being concurrently prescribed alongside metformin .

While recognizing that some purchased medication may not have been taken, in the absence of information on missed medications, our analysis was based on the assumption that the amount purchased equaled the amount consumed.

Which Cancer Treatments Can Affect Diabetes

Some cancer treatments can affect blood sugar levels. Ask your health care team about this risk for your specific cancer treatment plan and how to manage it.

Your health care team can also help you make a plan for monitoring and managing your blood sugar levels during cancer treatment. This may mean:

• Checking your blood sugar level more often

• Adjusting the dose of a current medication

• Starting a new diabetes medication

Chemotherapy. Certain types of chemotherapy are associated with high blood sugar. They include 5-fluorouracil -based chemotherapy, asparaginase , busulfan , and platinum-based chemotherapy, such as cisplatin . Also if you already have nerve damage from diabetes, some chemotherapy drugs can make it worse.

Steroid medications. Steroids can cause high blood sugar by increasing insulin resistance. This means the body does not respond properly to insulin. Steroids are also called corticosteroids or glucocorticoids. Your doctor may prescribe steroids to treat side effects of cancer and its treatment, such as nausea and pain. Or, steroids may be part of the treatment for the cancer itself. Commonly used steroids include dexamethasone, hydrocortisone, prednisone, and methylprednisolone .

To help keep your blood sugar stable, you may get steroids in several smaller doses instead of 1 large dose. Or you may receive it over a longer period of time through an intravenous tube. You may also need more insulin or need to start using it while on steroids.

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Is There A Meaningful Association Between Diabetes And Cancer Incidence Or Prognosis

Both diabetes and cancer are prevalent diseases whose incidence is increasing globally. Worldwide, the prevalence of cancer has been difficult to establish because many areas do not have cancer registries, but in 2008 there were an estimated 12.4 million new cancer cases diagnosed. The most commonly diagnosed cancers are lung/bronchus, breast, and colorectal, whereas the most common causes of cancer deaths are lung, stomach, and liver cancer . In the U.S., the most commonly diagnosed cancers are prostate, lung/bronchus, and colon/rectum in men and breast, lung/bronchus, and colon/rectum in women. Of the world population between the ages of 20 and 79 years, an estimated 285 million people, or 6.6%, have diabetes . In 2007, diabetes prevalence in the U.S. was 10.7% of persons aged 20 years and older , with an estimated 1.6 million new cases per year. Type 2 diabetes is the most common form, accounting for 95% of prevalent cases . Worldwide, cancer is the 2nd and diabetes is the 12th leading cause of death . In the U.S., cancer is the 2nd and diabetes is the 7th leading cause of death the latter is likely an underestimate, since diabetes is underreported on death certificates as both a cause and comorbid condition .

How Can I Manage My Diabetes During Cancer Treatment

Talk to your health care team about how to manage your diabetes during cancer treatment. They can provide information, monitor your health, and help you find the best support and resources that you need.

Follow a healthy eating plan. Eating healthy, well-timed meals helps keep your blood sugar balanced. Eating well also gives your body essential nutrients it needs during cancer treatment. An oncology dietitian can help you develop an eating plan based on your health issues and needs.

Get regular exercise. Exercise during cancer treatment helps your body use blood sugar. Physical activity can also help you stay at a healthy weight, which is an important part of managing diabetes.

Track your health. Use a journal or a free app like Cancer.Net Mobile to track your cancer treatments, your blood sugar level, diabetes medications, other medications, and side effects. This information can help you and your doctor pinpoint any health issues and their causes.

Manage stress. Stress from cancer and its treatments can cause your body to release various hormones that increase blood sugar. This can weaken your immune system. Stress management strategies can help you feel more relaxed and less anxious.

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Ascertainment Of Prostate Cancer Cases

Incident prostate cancers were initially self-reported on questionnaires, followed by confirming cancer diagnosis and extracting clinical and treatment information through medical records and pathology reports. Deaths were reported by family members, or identified through the National Death Index, with > 98% sensitivity Prostate cancer-specific death was determined by review of death certificates and medical records by an endpoint committee of physicians. Archival prostate tumour tissue from about half of HPFS participants diagnosed with prostate cancer was retrieved and undergone central histopathologic reviewed by study pathologists for the standardised tumour grading.

Stage T1a prostate cancer cases were excluded from this analysis since these cases are incidentally diagnosed and prone to detection bias. We classified clinical subtypes of prostate cancer as localised , advanced , lethal low-grade , intermediate-grade , and high-grade prostate cancer using information from prostatectomy or biopsy pathology reports.

The Role Of Testosterone In Heart Disease

Low levels of testosterone can affect the amount of fat in your body. It might also affect where it collects in your body.

Low levels of testosterone can:

• cause fat can build up around your tummy , this is called central obesity
• increase the amount of fats called cholesterol in your blood

If you already have heart problems, this might affect which treatment is best for you. Talk to your doctor about your heart problems before starting treatment.

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Conclusions And Further Perspectives

Due to the increase in predicted average lifetime and incidence of diabetes, it can be expected that an increased focus on the efficacy of treatment of prostate cancer, as well as the quality of life of such patients will result. The co-existence of these two chronic diseases may require some modifications in the treatment of diabetes. This review aimed to investigate currently known information about the impact of commonly used antidiabetic drugs on the incidence and progression of PC. Crawley and co-authors of a systematic review emphasize the complex relationship between PC and T2DM, not only in terms of the prevalent co-existence but also their impact on the course of the disease, mortality, and interaction between T2DM and PC management . We briefly investigated the outcomes of pre-clinical studies and we looked for its correlation with available clinical trials ). Available reports and meta-analyses demonstrate that most anti-diabetic drugs do not increase the risk during the treatment of patients with PC. However, some reports show a potential advantage of T2DM treatment with specific drugs, particularly in the light of the recent reports about metformin as a possible therapeutic option. The effect of other widely used anti-diabetic drugs on PC should be considered. Moreover, in the study of Tsutsumi and co-researchers, Met anticancer properties were augmented while combined with the GLP-1 analog exendin-4 .

Management Of Diabetes Affects Survival Rates In Prostate Cancer Patients

PHILADELPHIA Prostate cancer is the second most common cancer found in men in the United States, affecting 14 percent, whereas diabetes affects about 9 percent of the population. Even though both conditions are often present in the same individual, it has not been clear how a diabetes diagnosis affects clinical outcomes for prostate cancer. Research at Fox Chase Cancer Center Temple Health showed that the answer depends on what type of anti-diabetic drugs, if any, prostate cancer patients are taking.

The implication of the study is that prevention and control of diabetes is important, particularly among cancer patients, said lead study investigator Nicholas G. Zaorsky, MD, resident physician in radiation oncology at Fox Chase. Men who are having their prostate cancer treated should be mindful of any other conditions they have been diagnosed with, and they should continue to see physicians who will manage these conditions appropriately.

To examine the link between diabetes and prostate cancer, Zaorsky and his collaborators reviewed their prospectively collected institutional database of 3,176 men undergoing intensity-modulated radiation therapy for localized prostate cancer. They then compared the outcomes of the 2,576 patients without a history of type 2 diabetes and the 600 patients with a history of type 2 diabetes.

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Findings From Large Cohort Study Do Not Support One Leading Hypothesis Researchers Say

byJeff Minerd, Contributing Writer, MedPage Today November 6, 2019

Men with diabetes may appear to be at lower risk for prostate cancer because they are less likely to get a biopsy when they have elevated prostate-specific antigen , a large cohort study suggested.

The study, which included data on 564,666 men followed for 10 years, found that the likelihood of undergoing a biopsy after elevated PSA was lower among men receiving metformin and insulin compared with men without diabetes, reported Kerri Beckmann, PhD, of King’s College London, and colleagues.

As shown in their study online in JAMA Network Open, there were no differences in prostate cancer detection at biopsy in men with diabetes, regardless of the PSA level that triggered the biopsy. “This study’s findings do not support the hypothesis that the inverse association between diabetes and prostate cancer is mediated through antidiabetic medications lowering PSA levels to mask prostate cancer,” the researchers said. “They do suggest potential detection bias due to fewer biopsies among men receiving antidiabetic medications, which may explain the lower prostate cancer risk in men with diabetes.”

To explore potential links, Beckmann’s team analyzed data on the 564,666 initially prostate cancer-free men ages 40-79 from the Stockholm PSA and Biopsy Registry. Of these, 4,583 were prescribed metformin, 1,104 sulfonylureas, and 978 insulin.

Disclosures

Velaer and Leppert reported no conflicts of interest.

Journal Of Urology Study

A study from the Journal of Urology in June of 2000 showed that the symptoms of benign prostatic hyperplasia tend to be worse in those with diabetes.

This study looked at records of patients undergoing drug treatment for benign prostatic hyperplasia. The sample included 1290 men with diabetes and 8566 without.

Researchers compared symptoms of benign prostatic hyperplasia before and after drug treatment. They found that those with diabetes had more symptoms and a slower urine flow rate.

Moreover, they also found that diabetic men have symptoms as severe as non-diabetic patients eleven years older. They also had a urine flow rate similar to men without diabetes who were seven years older than them.

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Strengths And Limitations Of This Study

• Large population design of Prostate Cancer database.

• Large numbers of men with type 2 diabetes included.

• Inclusion of a large number of men who subsequently developed PCa as well as information on PCa treatment received.

• No serial measurements of haemoglobin A1c were available, so proxy of escalations in pharmacological treatment was used to assess T2DM control.

Dr J Kellogg Parsons Study

Dr. J. Kellogg Parsons is from the University of California at San Diego. They studied the association between benign prostatic hyperplasia and other factors. These factors included obesity, blood glucose concentration, and diabetes.

They looked at 422 men between the ages of 27 and 84 and used MRI technology to measure prostate size.

They found that 91 of these men had an enlarged prostate. Moreover, they also found that blood glucose concentration was associated with a risk of prostate enlargement.

In fact, patients with high glucose had three times the risk of having an enlarged prostate. Patients with diabetes were more than double as likely to have an enlarged prostate than their peers who did not have diabetes.

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How To Manage Diabetes And Cancer Treatment

Between 8% and 18% of cancer patients have diabetes, a chronic condition that impacts the ability to regulate blood sugar levels. And, for many patients, diabetes management takes a backseat to cancer treatment. But managing your blood sugar levels can help your overall health.

We spoke with Erma Levy, a research dietitian at MD Anderson, about what cancer patients with diabetes should know.

Can cancer treatment affect blood sugar levels?

Radiation therapy, steroids and some types of chemotherapy may impact your blood sugar levels. And uncontrolled high blood sugar can lead to dehydration, which is a frequent side effect of chemotherapy. Taking extra care to manage your blood sugar levels can help you stay hydrated and feel better during treatment.

Uncontrolled blood sugar levels also can have a negative impact on your other organs. Monitoring your blood sugar levels can help keep them healthy and strong during cancer treatment.

What can cancer patients with diabetes do to improve their health?

If you have Type II diabetes or pre-diabetes , try to manage it through your diet. As your diet allows, focus on a healthy eating plan thats rich in fruits, vegetables and whole grains and low in fat and calories. You can help keep your blood sugar level in a safe range by ensuring theres a balance of these foods in your diet throughout the day.

What should cancer survivors with diabetes do to lower their risk of recurrence?