Abstract
Aims/Objectives: This thesis aims to explore the interplay between type two diabetes mellitus (T2DM) and prostate cancer (PCa) with regards to treatments of both conditions and disease outcomes.Background: PCa and T2DM are both increasingly prevalent conditions, meaning that they often occur together. However, the relationship between the two is complex.
Plan of investigation/Methods: To investigate the complex interplay between the two, the thesis was divided into the following projects:
(1) Using data from Prostate Cancer data Base Sweden (PCBaSe) Sweden this thesis investigated:
i) the impact of co-existing T2DM on receiving curative treatment for PCa
ii) the impact of a PCa diagnosis on T2DM treatment
iii) how the type and duration of androgen deprivation therapy (ADT) may affect risk of getting T2DM
(2) Evaluation of whether presence of T2DM and other components of the metabolic syndrome (MetS) affects response to ADT using data from patients enrolled in the STAMPEDE trial
(3) Assessment of which tumour components are affected by metformin through a randomised controlled trial, METAL (Metformin And Longevity).
Results: Men with T2DM were 20% less likely to receive curative treatment for intermediate and high risk PCa compared to those without T2DM after adjusting for age, co-morbidity and tumour characteristics. Moreover, men with pre-existing T2DM were at increased risk of needing treatment escalations following a PCa diagnosis, particularly those treated with ADT. An increased risk of T2DM following treatment with ADT was also shown in which the duration and type of ADT received was important. Finally, baseline metabolic aberrations, including T2DM, in men commencing ADT for advanced PCa increased the risk of local and metastatic progression.
Conclusion: This thesis highlights the complexity of the interplay between T2DM and PCa, in which both conditions impact on both the treatment and disease outcomes of the other.
| Date of Award | 2018 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Mieke Van Hemelrijck (Supervisor) & Sarah Rudman (Supervisor) |