The suggested chemopreventive association of metformin with prostate cancer in diabetic patients
Goldberg H, Mohsin FK, Berlin A, Chandrasekar T, Wallis CJD, Klaassen Z, Ahmad AE, Saskin R, Kenk M, Saarela O, Kulkarni GS, Alibhai SMH, Fleshner N. Urol Oncol. 2021; 39(3):191.e17-.e24. Epub 2020 Sep 17. DOI: https://doi.org/10.1016/j.urolonc.2020.08.032
Purpose — Metformin, an insulin sensitizer, is the most common first-line antidiabetic therapy. There is increasing evidence suggesting metformin can prevent the emergence of prostate cancer (CaP). We aimed to analyze the chemopreventive role of metformin, in conjunction with other putative chemopreventive medications (statins, proton-pump-inhibitors, alpha-blockers, 5-alpha-reductase inhibitors, diabetic medications) in a population-based cohort study.
Methods — Data were incorporated from the Institute for Clinical and Evaluative Sciences to identify all diabetic men aged 66 and above with prior history of a negative prostate biopsy (PB) between 1994 and 2016, who were not on any of the medications prior to study inclusion. Multivariable Cox regression models with time-dependent covariates were used to assess the association of metformin to CaP diagnosis, subsequent PB, and use of androgen deprivation therapy (ADT). All models were adjusted for age, rurality, comorbidity, and year of study inclusion.
Results — Overall, 2,332 diabetic men were included, with a median follow-up time of 9.4 years (interquartile range 5.4–13.4 years). A total of 2,036 patients (87.3%) received metformin. Compared to non-metformin users, metformin use was associated with decreased CaP diagnosis rate (HR 0.69, 95%CI 0.54–0.88, P = 0.003), lower hazard of undergoing an additional PB (HR 0.64, 95%CI 0.44–0.95, P = 0.03), and receiving ADT (HR 0.72, 95%CI 0.54–0.96, P = 0.003).
Conclusion — Men receiving metformin were less likely to have suspected or diagnosed CaP, and in those with CaP, the use of ADT was less common. Ongoing prospective randomized studies will determine if these findings correspond to the suggested associations of metformin in the emergence and/or progression of CaP.