高血糖症與攝護腺癌使用去勢療法之相關性

耿俊閎^1,2,3,4, 張哲維^2,3,4

美國哈佛醫學院 布萊根婦女醫院 泌尿外科¹；高雄市市立小港醫院 泌尿部²；高雄醫學大學附設醫院 泌尿部³；高雄醫學大學⁴

Hyperglycemia and risk of progression to castration-resistance in men with metastatic hormone sensitive prostate cancer

Jiun-Hung Geng^1,2,3,4, Che-Wei Chang^2,3,4

¹ Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, ² Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan, ³ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ⁴ Kaohsiung Medical University, Kaohsiung, Taiwan

Purpose:

We tested the association of serum glucose levels during the course of androgen deprivation therapy with the risk of progression to castration resistant prostate cancer (CRPC).

Materials and Methods:

We identified 173 men with metastatic castration-sensitive prostate cancer treated with first line androgen deprivation therapy (ADT) from 1996 to 2013 and had available serum glucose data prior to starting ADT. Cox proportional hazards models were used to test associations between initial serum glucose level and the risk of CRPC while adjusting for potential confounders.

Results:

Median follow up after androgen deprivation therapy was 56 months. CRPC developed in 120 men. On multivariable analysis, elevated serum glucose level (more than 125mg/dl vs less than 100mg/dl) was associated with an increased risk of progression to castration resistant prostate cancer (HR 2.032, 95% CI 1.209-3.416). Men who had serum glucose elevations greater than 10, 20, 50 units over the upper limit of normal had a 13%, 27%, 82% increase risk of progression to CRPC.

Conclusion:

Among men with metastatic castration-sensitive prostate cancer who started androgen deprivation therapy, an elevated serum glucose prior to treatment was associated with risks of increased CRPC. Further studies are needed to explore a potential role for glucose in prostate cancer progression after androgen deprivation therapy and if tighter control of glucose could decrease progression.