Outcomes of prostate cancer screening among men using antidiabetic medication

Abstract Diabetic men have decreased risk for prostate cancer (PCa) overall and lower PSA compared to non-diabetics. This may affect the outcomes of PSA-based screening. We investigated the effect of PSA-based screening at 4-year intervals on PCa incidence and mortality separately among users and no...

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Autores principales:	A. Vettenranta, T. J. Murtola, K. Talala, K. Taari, U.-H. Stenman, T. L. J. Tammela, A. Auvinen
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4c87bb3f20a146979b5d700888507321
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spelling	oai:doaj.org-article:4c87bb3f20a146979b5d7008885073212021-12-02T14:25:27ZOutcomes of prostate cancer screening among men using antidiabetic medication10.1038/s41598-021-86534-22045-2322https://doaj.org/article/4c87bb3f20a146979b5d7008885073212021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-86534-2https://doaj.org/toc/2045-2322Abstract Diabetic men have decreased risk for prostate cancer (PCa) overall and lower PSA compared to non-diabetics. This may affect the outcomes of PSA-based screening. We investigated the effect of PSA-based screening at 4-year intervals on PCa incidence and mortality separately among users and non-users of antidiabetic medication with the hypothesis that screening would detect less low-grade cancer and more high-grade cancer in diabetic men. A cohort of 80,458 men from the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC) were linked to national prescription database to obtain information on antidiabetic medication purchases. PCa risk and mortality were compared between the FinRSPC screening arm (SA) and the control arm (CA) separately among users and non-users of antidiabetic medication. Among antidiabetic medication users median PSA was lower than in non-users (0.93 and 1.09 ng/ml, respectively, P for difference = 0.001). Screening increased overall PCa incidence compared to CA after the first screen both among medication users and non-users (HR 1.31, 95% CI 1.08–1.60 and HR 1.55, 95% CI 1.44–1.66, respectively). On the second and third screen the difference between SA and CA attenuated only among medication users. Detection of Gleason 6 tumors was lower among medication users, whereas no difference was observed in detection of Gleason 8–10 cancers. Concordantly, screening affected PCa mortality similarly regardless of antidiabetic medication use (HR 0.38, 95% CI 0.14–1.07 and HR 0.19, 95% CI 0.11–0.33 among users and non-users after three screens, respectively. P for difference = 0.18). Median PSA is lower in men using antidiabetic drugs than among non-users. Systematic PSA screening detects less low-risk tumors among medication users, whereas detection of high-risk tumors and mortality effects are similar regardless of medication use. This suggests that antidiabetic medication users may form a suitable target group for PCa screening, with less screening-related overdiagnosis of indolent tumors.A. VettenrantaT. J. MurtolaK. TalalaK. TaariU.-H. StenmanT. L. J. TammelaA. AuvinenNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q A. Vettenranta T. J. Murtola K. Talala K. Taari U.-H. Stenman T. L. J. Tammela A. Auvinen Outcomes of prostate cancer screening among men using antidiabetic medication
description	Abstract Diabetic men have decreased risk for prostate cancer (PCa) overall and lower PSA compared to non-diabetics. This may affect the outcomes of PSA-based screening. We investigated the effect of PSA-based screening at 4-year intervals on PCa incidence and mortality separately among users and non-users of antidiabetic medication with the hypothesis that screening would detect less low-grade cancer and more high-grade cancer in diabetic men. A cohort of 80,458 men from the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC) were linked to national prescription database to obtain information on antidiabetic medication purchases. PCa risk and mortality were compared between the FinRSPC screening arm (SA) and the control arm (CA) separately among users and non-users of antidiabetic medication. Among antidiabetic medication users median PSA was lower than in non-users (0.93 and 1.09 ng/ml, respectively, P for difference = 0.001). Screening increased overall PCa incidence compared to CA after the first screen both among medication users and non-users (HR 1.31, 95% CI 1.08–1.60 and HR 1.55, 95% CI 1.44–1.66, respectively). On the second and third screen the difference between SA and CA attenuated only among medication users. Detection of Gleason 6 tumors was lower among medication users, whereas no difference was observed in detection of Gleason 8–10 cancers. Concordantly, screening affected PCa mortality similarly regardless of antidiabetic medication use (HR 0.38, 95% CI 0.14–1.07 and HR 0.19, 95% CI 0.11–0.33 among users and non-users after three screens, respectively. P for difference = 0.18). Median PSA is lower in men using antidiabetic drugs than among non-users. Systematic PSA screening detects less low-risk tumors among medication users, whereas detection of high-risk tumors and mortality effects are similar regardless of medication use. This suggests that antidiabetic medication users may form a suitable target group for PCa screening, with less screening-related overdiagnosis of indolent tumors.
format	article
author	A. Vettenranta T. J. Murtola K. Talala K. Taari U.-H. Stenman T. L. J. Tammela A. Auvinen
author_facet	A. Vettenranta T. J. Murtola K. Talala K. Taari U.-H. Stenman T. L. J. Tammela A. Auvinen
author_sort	A. Vettenranta
title	Outcomes of prostate cancer screening among men using antidiabetic medication
title_short	Outcomes of prostate cancer screening among men using antidiabetic medication
title_full	Outcomes of prostate cancer screening among men using antidiabetic medication
title_fullStr	Outcomes of prostate cancer screening among men using antidiabetic medication
title_full_unstemmed	Outcomes of prostate cancer screening among men using antidiabetic medication
title_sort	outcomes of prostate cancer screening among men using antidiabetic medication
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/4c87bb3f20a146979b5d700888507321
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Outcomes of prostate cancer screening among men using antidiabetic medication

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