14 results on '"Crawley, Danielle"'
Search Results
2. Are you now a good surgeon? T2 positive margin status as a quality outcome measure following radical prostatectomy
- Author
-
Damani, Arees, Van Hemelrijck, Mieke, Wulaningsih, Wahyu, Crawley, Danielle, and Cahill, Declan
- Published
- 2017
- Full Text
- View/download PDF
3. Exploring the association between use of gonadotropin releasing hormones agonists and prostate cancer diagnosis per se and diabetes control in men with type 2 diabetes mellitus: a nationwide, population-based cohort study.
- Author
-
Lin, E., Garmo, Hans, Van Hemelrijck, Mieke, Adolfsson, Jan, Stattin, Pär, Zethelius, Björn, and Crawley, Danielle
- Subjects
GONADOTROPIN releasing hormone ,PROSTATE cancer ,TYPE 2 diabetes ,CANCER diagnosis ,GLYCEMIC control ,DIAGNOSIS of diabetes ,DIABETES - Abstract
Background: Gonadotropin Releasing Hormones agonists (GnRH), which are first line treatment for metastatic prostate cancer (PCa), increase risk of type 2 diabetes mellitus (T2DM). This study aims to quantify the association of use of GnRH with diabetes control in PCa men with T2DM.Methods: Nationwide population-based cohort study in the Swedish National Diabetes Register and Prostate Cancer data Base Sweden 4.1, on the association between GnRH and diabetes control in T2DM men with PCa by comparing T2DM men with PCa vs. without PCa, as well as comparing T2DM men with PCa on or not on GnRH. The primary exposure was use of GnRH. Worsening diabetes control was the primary outcome, defined as: 1) HbA1c rose to 58 mmol/mol or higher; 2) HbA1c increase by 10 mmol/mol or more; 3) Start of antidiabetic drugs or switch to insulin. We also combined all above definitions. Cox proportional hazards regression was used to analyze the association.Results: There were 5714 T2DM men with PCa of whom 692 were on GnRH and 28,445 PCa-free men with T2DM with similar baseline characteristics. Diabetes control was worse in men with GnRH vs. PCa-free men (HR: 1.24, 95% CI: 1.13-1.34) as well as compared with PCa men without GnRH (HR:1.58, 95% CI: 1.39-1.80), when we defined the worsening control of diabetes by combining all definitions above.Conclusion: Use of GnRH in T2DM men with PCa was associated with worse glycemic control. The findings highlight the need to closely monitor diabetes control in men with T2DM and PCa starting GnRH. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
4. Metabolic syndrome biomarkers and prostate cancer risk in the UK Biobank.
- Author
-
Monroy‐Iglesias, Maria J., Russell, Beth, Crawley, Danielle, Allen, Naomi E., Travis, Ruth C., Perez‐Cornago, Aurora, Van Hemelrijck, Mieke, and Beckmann, Kerri
- Subjects
SOMATOMEDIN C ,METABOLIC syndrome ,DYSLIPIDEMIA ,PROSTATE cancer ,BIOMARKERS ,TYPE 2 diabetes ,GLYCOSYLATED hemoglobin - Abstract
We investigated the association between metabolic syndrome (MetS) and its components and risk of prostate cancer (PCa) in a cohort of men enrolled in the UK Biobank. Our study cohort included 220 622 PCa‐free men with baseline measurements of triglycerides (TGs), HDL‐cholesterol (HDL), glycated hemoglobin (HbA1c), blood pressure (BP), and waist circumference (WC). Multivariable Cox proportional hazards regression was used to analyze associations with PCa for: individual metabolic components (TG, HDL, HbA1c, BP, WC), combinations of two and three components, and MetS overall (three or more components). We conducted mediation analyses to examine potential hormonal and inflammatory pathways (total testosterone [TT], C‐reactive protein [CRP], insulin‐like growth factor 1 [IGF‐1]) through which MetS components may influence PCa risk. A total of 5409 men in the study developed PCa during a median follow‐up of 6.9 years. We found no significant association between MetS and PCa risk (hazard ratio [HR] = 0.99, 95% confidence interval [CI] = 0.92‐1.06). No associations were found with PCa risk and individual measurements of TG, HDL, BP, or WC. However, an inverse association was observed with elevated HbA1c (≥42 mmol/mol) (HR = 0.89, 95% CI = 0.79‐0.98). Consistent inverse associations were observed between HbA1c and risk of PCa. Mediation analysis revealed TT, CRP, and IGF‐1 as potential mediating factors for this association contributing 10.2%, 7.1%, and 7.9% to the total effect, respectively. Overall MetS had no association with PCa risk. However, a consistent inverse association with PCa risk was found for HbA1c. This association may be explained in part through hormonal and inflammatory pathways. What's new? Risk of prostate cancer is variously linked to obesity, type 2 diabetes mellitus, and other components of metabolic syndrome (MetS). Evidence for a clear association between prostate cancer and MetS and its components, however, remains elusive. In this large, prospective study, the authors found that MetS is not significantly associated with risk of prostate cancer. Glycated hemoglobin (HbA1c), however, was found to be inversely associated with risk. Analyses examining potential hormonal and inflammatory pathways identified total testosterone, C‐reactive protein, and insulin‐like growth factor 1 as potential mediating factors for the association between HbA1c and prostate cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
5. Use of Warfarin or Direct Oral Anticoagulants and Risk of Prostate Cancer in PCBaSe: A Nationwide Case-Control Study.
- Author
-
Parker, Jonathan, Crawley, Danielle, Garmo, Hans, Lindahl, Bertil, Styrke, Johan, Adolfsson, Jan, Lambe, Mats, Stattin, Pär, Van Hemelrijck, Mieke, and Beckmann, Kerri
- Subjects
WARFARIN ,ANTICOAGULANTS ,CASE-control method ,MARITAL status ,ODDS ratio ,PROSTATE cancer ,CASTRATION-resistant prostate cancer - Abstract
Existing literature examining warfarin's association with prostate cancer (PCa) risk provides conflicting results, while the association with direct oral anticoagulants (DOACs) has not yet been studied. We investigated the association of warfarin and DOAC use on PCa risk among men within the population-based Prostate Cancer database Sweden (PCBaSe), using a case-control design. The study population included PCa cases diagnosed 2014–2016 and five age-matched PCa-free controls. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CI) for PCa associated with warfarin and DOAC use, adjusted for marital status, education level, other drug use, and comorbidities. Among 31,591 cases and 156,802 controls, there were 18,522 (9.8%) warfarin and 4,455 (2.4%) DOAC users. Warfarin ever-use was associated with reduced risk of PCa overall (OR 0.92 95% CI 0.88–0.96) as were both past and current use. DOAC use was not associated with PCa risk. For some warfarin exposures, decreased risk was observed for unfavorable PCa (high risk/locally advanced/distant metastatic) but not with favorable PCa (low/intermediate risk). Increased risk of favorable PCa was observed for men whose initial warfarin exposure occurred in the 12 month period before diagnosis (OR 1.39; 95% CI 1.13–1.70). Our findings are consistent with previous publications reporting decreased PCa risk with warfarin exposure. Increased risk of favorable PCa suggests detection bias due to increased prostate specific antigen testing when starting on warfarin. Decreased overall PCa risk could reflect bias due to reduced biopsy rates among long-term warfarin users. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
6. Association of type 2 diabetes mellitus and antidiabetic medication with risk of prostate cancer: a population-based case-control study.
- Author
-
Lin, E., Garmo, Hans, Van Hemelrijck, Mieke, Adolfsson, Jan, Stattin, Pär, Zethelius, Björn, and Crawley, Danielle
- Subjects
TYPE 2 diabetes ,PROSTATE cancer ,CASE-control method - Abstract
Background: Prostate cancer (PCa) and type 2 diabetes mellitus (T2DM) are prevalent conditions that often occur concomitantly. However, many aspects of the impact of T2DM, particularly the duration of T2DM and antidiabetic medications, on PCa risk are poorly understood.Methods: To assess the association of duration of T2DM and antidiabetic medication with PCa risk, we designed a matched case-control study, including 31,415 men with PCa and 154,812 PCa-free men in Prostate Cancer data Base Sweden (PCBaSe) 4.1.Results: Overall, a decreased risk of PCa was observed for men with T2DM (odds ratio (OR): 0.81, 95% confidence interval (CI): 0.78-0.84), as compared to men without T2DM. The decreased risk of PCa was consistently showed across duration of T2DM. With respect to use of antidiabetic drugs, this inverse association with duration was also found for all medications types, as compared to men without T2DM, including insulin, metformin and sulphonylurea (SU) (e.g. 3- < 5 yr insulin OR:0.69, 95%CI:0.60-0.80; 3- < 5 yr metformin OR: 0.82, 95%CI: 0.74-0.91; 3- < 5 yr SU OR: 0.72, 95%CI: 0.62-0.83). When stratifying by PCa risk categories, this decreased risk was most evident for diagnosis of low and intermediate-risk PCa (low-risk OR: 0.65, 95%CI: 0.66-0.70, intermediate-risk OR: 0.80, 95%CI: 0.75-0.85).Conclusions: The study showed an inverse association between pre-existing T2DM and PCa across different durations of T2DM and all types of T2DM medication received. This inverse association was most evident for low- and intermediate-risk PCa, suggesting that whilst T2DM and its medication may protect some men from developing PCa, the relationship warrants further study. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
7. Association between duration and type of androgen deprivation therapy and risk of diabetes in men with prostate cancer
- Author
-
Crawley, Danielle, Garmo, Hans, Rudman, Sarah, Stattin, Pär, Häggström, Christel, Zethelius, Björn, Holmberg, Lars, Adolfsson, Jan, and Van Hemelrijck, Mieke
- Subjects
Male ,Risk ,Antineoplastic Agents, Hormonal ,endocrine system diseases ,androgen deprivation therapy ,Endocrinology and Diabetes ,Biomarkers, Tumor ,Humans ,Registries ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Aged, 80 and over ,Sweden ,Cancer och onkologi ,Incidence ,Prostatic Neoplasms ,Androgen Antagonists ,Middle Aged ,prostate cancer ,Diabetes Mellitus, Type 2 ,Cancer and Oncology ,Endokrinologi och diabetes ,type two diabetes ,Neoplasm Grading ,Orchiectomy ,Cancer Epidemiology - Abstract
Androgen deprivation therapy (ADT) for prostate cancer (PCa) increases risk of type 2 diabetes (T2DM); however the association between types and duration of ADT has not been fully elucidated. We examined how type and duration of ADT affects risk of T2DM. Using data from Prostate Cancer database Sweden (PCBaSe) we investigated risk of T2DM in a cohort of 34,031 men with PCa on ADT; i.e., anti‐androgens (AA), orchiectomy, or gonadotropin‐releasing hormone (GnRH) agonists compared to an age‐matched, PCa‐free comparison cohort (n = 167,205) using multivariate Cox proportional hazard regression. T2DM was defined as a newly filled prescription for metformin, sulphonylurea, or insulin in the Prescribed Drug Register. A total of 21,874 men with PCa received GnRH agonists, 9,143 AA and 3,014 underwent orchiectomy. Risk of T2DM was increased in men in the GnRH agonists/orchiectomy group during the first 3 years of ADT [i.e., 1 − 1.5 years HR: 1.61 (95%CI: 1.36 − 1.91)], compared to PCa‐free men. The risk decreased thereafter (e.g., 3 − 4 years HR: 1.17 (95% CI: 0.98 − 1.40)). Conversely, no increased risk was seen in men on AA (HR: 0.74 (95%CI: 0.65 − 0.84). The incidence of T2DM per 1,000 person‐years was 10 for PCa‐free men, 8 for men on AA, and 13 for men on GnRH agonists/orchiectomy. Duration of ADT has a significant impact on risk of T2DM. With the peak after three years of treatment, our data indicates that men on ADT, even for a limited period of time, such as adjuvant to radiotherapy, are at increased risk of T2DM., What's new? All treatments involve tradeoffs. For patients with prostate cancer, treatment with androgen deprivation therapy (ADT) can lead to an increased risk of type II diabetes. These authors set out to analyze how the duration of treatment, and the type of ADT, affect diabetes risk. They collected data on patients receiving three types of ADT: anti‐androgens, gonadotropin releasing hormone agonists, and orchiectomy, and compared them with age‐matched, cancer‐free controls. The risk of diabetes peaked after 3 years of treatment with GnRH agonists or orchiectomy. By contrast, patients receiving anti‐androgens showed no increase in diabetes risk relative to cancer‐free controls.
- Published
- 2016
8. A systematic review of the literature exploring the interplay between prostate cancer and type two diabetes mellitus.
- Author
-
Crawley, Danielle, Chamberlain, Florence, Garmo, Hans, Rudman, Sarah, Zethelius, Björn, Holmberg, Lars, Adolfsson, Jan, Stattin, Par, Carroll, Paul, and Van Hemelrijck, Mieke
- Subjects
- *
PROSTATE cancer , *TYPE 2 diabetes , *SYSTEMATIC reviews - Abstract
Prostate cancer (PCa) and type two diabetes mellitus (T2DM) are both increasing prevalent conditions and often occur concurrently. However, the relationship between the two is more complex than just two prevalent conditions co-existing. This review systematically explores the literature around the interplay between the two conditions. It covers the impact of pre-existing T2DM on PCa incidence, grade and stage, as well as exploring the impact of T2DM on PCa outcomes and mortality and the interaction between T2DM and PCa treatments. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
9. Metformin and longevity (METAL): a window of opportunity study investigating the biological effects of metformin in localised prostate cancer.
- Author
-
Crawley, Danielle, Chandra, Ashish, Loda, Massimo, Gillett, Cheryl, Cathcart, Paul, Challacombe, Ben, Cook, Gary, Cahill, Declan, Olalla, Aida Santa, Cahill, Fidelma, George, Gincy, Rudman, Sarah, Van Hemelrijck, Mieke, and Santa Olalla, Aida
- Subjects
- *
METFORMIN , *TYPE 2 diabetes , *BIGUANIDE , *HYPOGLYCEMIC agents , *PROSTATE cancer , *ANTINEOPLASTIC agents , *CELLULAR signal transduction , *COMPARATIVE studies , *EXPERIMENTAL design , *LONGEVITY , *RESEARCH methodology , *MEDICAL cooperation , *PROSTATE tumors , *RESEARCH , *RESEARCH funding , *STATISTICAL sampling , *EVALUATION research , *RANDOMIZED controlled trials , *BLIND experiment , *PHARMACODYNAMICS - Abstract
Background: Metformin is a biguanide oral hypoglycaemic agent commonly used for the treatment of type 2 diabetes mellitus. In addition to its anti-diabetic effect, metformin has also been associated with a reduced risk of cancer incidence of a number of solid tumours, including prostate cancer (PCa). However, the underlying biological mechanisms for these observations have not been fully characterised in PCa. One hypothesis is that the indirect insulin lowering effect may have an anti-neoplastic action as elevated insulin and insulin like growth factor - 1 (IGF-1) levels play a role in PCa development and progression. In addition, metformin is a potent activator of activated protein kinase (AMPK) which in turn inhibits the mammalian target of rapamycin (mTOR) and other signal transduction mechanisms. These direct effects can lead to reduced cell proliferation. Given its wide availability and tolerable side effect profile, metformin represents an attractive potential therapeutic option for men with PCa. Hence, the need for a clinical trial investigating its biological mechanisms in PCa.Methods: METAL is a randomised, placebo-controlled, double-blind, window of opportunity study investigating the biological mechanism of metformin in PCa. 100 patients with newly-diagnosed, localised PCa scheduled for radical prostatectomy will be randomised 1:1 to receive metformin (1 g b.d.) or placebo for four weeks (+/- 1 week) prior to prostatectomy. Tissue will be collected from both diagnostic biopsy and prostatectomy specimens. The primary endpoint is the difference in expression levels of markers of the Fatty acid synthase (FASN)/AMPK pathway pre and post treatment between the placebo and metformin arms. Secondary endpoints include the difference in expression levels of indicators of proliferation (ki67 and TUNEL) pre and post treatment between the placebo and metformin arms. METAL is currently open to recruitment at Guy's and St Thomas' Hospital and the Royal Marsden Hospital, London.Discussion: This randomised placebo-controlled double blinded trial of metformin vs. placebo in men with localised PCa due to undergo radical prostatectomy, aims to elucidate the mechanism of action of metformin in PCa cells, which should then enable further larger stratification trials to take place.Trial Registration: EudraCT number 2014-005193-11 . Registered on September 09, 2015. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
10. Serum inflammatory markers in relation to prostate cancer severity and death.
- Author
-
Crawley, Danielle, Williams, Robert, Garmo, Hans, Holmberg, Lars, Stattin, Par, Malmstrom, Hakan, Lambe, Mats, Hammar, Niklas, Walldius, Goran, Robinson, David, Jungner, Ingmar, and Van Hemelrijck, Mieke
- Subjects
BIOMARKERS ,PROSTATE cancer ,LEUCOCYTES - Published
- 2018
- Full Text
- View/download PDF
11. Hormonal patterns in men with prediabetes and diabetes in NHANES III: possible links with prostate cancer
- Author
-
Kerri Beckmann, Danielle Crawley, William G. Nelson, Elizabeth A. Platz, Elizabeth Selvin, Mieke Van Hemelrijck, Sabine Rohrmann, University of Zurich, Beckmann, Kerri, Crawley, Danielle, Nelson, William G, Platz, Elizabeth A, Selvin, Elizabeth, Van Hemelrijck, Mieke, and Rohrmann, Sabine
- Subjects
Male ,Cancer Research ,610 Medicine & health ,insulin growth factor-I (IGF-I) ,Article ,Prediabetic State ,and sex steroids ,estradiol ,Sex Hormone-Binding Globulin ,Diabetes Mellitus ,Humans ,Testosterone ,1306 Cancer Research ,Insulin-Like Growth Factor I ,Prostatic Neoplasms ,10060 Epidemiology, Biostatistics and Prevention Institute (EBPI) ,prostate cancer ,Nutrition Surveys ,insulin growth factor-binding protein 3 (IGFBP-3) ,Cross-Sectional Studies ,Insulin-Like Growth Factor Binding Protein 3 ,Oncology ,diabetes mellitus ,testosterone ,2730 Oncology ,C-peptide - Abstract
Refereed/Peer-reviewed Purpose: Pathways involving sex hormones and insulin-like growth factors (IGFs) have been proposed to explain, in part, the lower risk of prostate cancer among men with diabetes. To gain insights into potential biological mechanisms we explored differences in serum concentrations of sex hormones and IGFs across the trajectory from normoglycemia to prediabetes to poorly controlled diabetes. Methods: Using cross-sectional data from the National Health and Nutrition Examination Survey III we examined differences in levels of circulating sex hormones, sex hormone-binding globulin (SHBG), IGF-1, and IFG-binding protein 3 (IGFBP-3), according to diabetes status: no diabetes [n = 648], prediabetes [n = 578], undiagnosed diabetes [n = 106], well-controlled diabetes [n = 42], and poorly controlled diabetes [n = 56]. Adjusted geometric mean concentrations were derived using multivariable linear regression, adjusted for age, race, and other lifestyle factors. Results: Total testosterone concentrations were lower among prediabetics (4.89 ng/mL, 95% confidence interval (CI) 4.95–5.21) than men without prediabetes/diabetes (5.29 ng/mL, 95% CI 5.06–5.53) but did not reduce further across diabetes groups. Concentrations of estradiol, estimated free testosterone, SHGB, IGF-1, and IGFBP-3 did not differ. While the ratio of IGF-1 to IGFBP-3 was lower among men with prediabetics and undiagnosed diabetes than men without prediabetes/diabetes, there was no trend across groups. A positive trend for the ratio of estradiol-to-testosterone levels was observed across groups (p trend = 0.045). Conclusion: Our findings do not provide clear support for either an androgen driven or IGF-driven pathway for the inverse association between diabetes and prostate cancer risk.
- Published
- 2022
12. Metabolic syndrome biomarkers and prostate cancer risk in the UK Biobank
- Author
-
Maria J. Monroy‐Iglesias, Beth Russell, Danielle Crawley, Naomi E. Allen, Ruth C. Travis, Aurora Perez‐Cornago, Mieke Van Hemelrijck, Kerri Beckmann, Monroy-Iglesias, Maria J, Russell, Beth, Crawley, Danielle, Allen, Naomi E, Travis, Ruth C, Perez-Cornago, Aurora, Van Hemelrijck, Mieke, and Beckmann, Kerri
- Subjects
Adult ,Male ,Oncology ,Cancer Research ,Inverse Association ,medicine.medical_specialty ,Waist ,Blood Pressure ,metabolic syndrome ,Cohort Studies ,03 medical and health sciences ,Prostate cancer ,chemistry.chemical_compound ,0302 clinical medicine ,Risk Factors ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Testosterone ,mediation analysis ,Triglycerides ,Aged ,Biological Specimen Banks ,Proportional Hazards Models ,Glycated Hemoglobin ,Metabolic Syndrome ,business.industry ,Cholesterol, HDL ,Hazard ratio ,Prostatic Neoplasms ,Middle Aged ,medicine.disease ,prostate cancer ,United Kingdom ,Confidence interval ,C-Reactive Protein ,chemistry ,030220 oncology & carcinogenesis ,Cohort ,Glycated hemoglobin ,Waist Circumference ,Metabolic syndrome ,business ,Biomarkers ,glycated hemoglobin - Abstract
We investigated the association between metabolic syndrome (MetS) and its components and risk of prostate cancer (PCa) in a cohort of men enrolled in the UK Biobank. Our study cohort included 220 622 PCa‐free men with baseline measurements of triglycerides (TG), HDL‐cholesterol (HDL), glycated haemoglobin (HbA1c), blood pressure (BP), and waist circumference (WC). Multivariable Cox proportional hazards regression was used to analyse associations with PCa for: individual metabolic components (TG, HDL, HbA1c, BP, WC), combinations of two and three components, and MetS overall (three or more components). We conducted mediation analyses to examine potential hormonal and inflammatory pathways (total testosterone (TT), C‐reactive protein (CRP), insulin‐like growth factor 1 (IGF‐1)) through which MetS components may influence PCa risk. A total of 5409 men in the study developed PCa during a median follow‐up of 6.9 years. We found no significant association between MetS and PCa risk (Hazard Ratio (HR): 0.99, 95% Confidence Interval (CI): 0.92‐1.06). No associations were found with PCa risk and individual measurements of TG, HDL, BP or WC. However, an inverse association was observed with elevated HbA1c (≥42 mmol/mol) (HR: 0.89, 95%CI: 0.79‐0.98). Consistent inverse associations were observed between HbA1c and risk of PCa. Mediation analysis revealed TT, CRP and IGF‐1 as potential mediating factors for this association contributing 10.2%, 7.1% and 7.9% to the total effect, respectively. Overall MetS had no association with PCa risk. However, a consistent inverse association with PCa risk was found for HbA1c. This association may be explained in part through hormonal and inflammatory pathways.
- Published
- 2021
13. Use of Warfarin or Direct Oral Anticoagulants and Risk of Prostate Cancer in PCBaSe : A Nationwide Case-Control Study
- Author
-
Jonathan Parker, Danielle Crawley, Hans Garmo, Bertil Lindahl, Johan Styrke, Jan Adolfsson, Mats Lambe, Pär Stattin, Mieke Van Hemelrijck, Kerri Beckmann, Parker, Jonathan, Crawley, Danielle, Garmo, Hans, Lindahl, Bertil, Styrke, Johan, Adolfsson, Jan, Lambe, Mats, Stattin, Pär, Van Hemelrijck, Mieke, and Beckmann, Kerri
- Subjects
0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,case-control study ,Population ,direct anticoagulant agents ,lcsh:RC254-282 ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Internal medicine ,Medicine ,education ,Original Research ,education.field_of_study ,Cancer och onkologi ,detection bias ,business.industry ,Warfarin ,Case-control study ,Odds ratio ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,prostate cancer ,Confidence interval ,warfarin ,Prostate-specific antigen ,030104 developmental biology ,Oncology ,030220 oncology & carcinogenesis ,Cancer and Oncology ,Population study ,business ,medicine.drug - Abstract
Refereed/Peer-reviewed Existing literature examining warfarin's association with prostate cancer (PCa) risk provides conflicting results, while the association with direct oral anticoagulants (DOACs) has not yet been studied. We investigated the association of warfarin and DOAC use on PCa risk among men within the population-based Prostate Cancer database Sweden (PCBaSe), using a case-control design. The study population included PCa cases diagnosed 2014–2016 and five age-matched PCa-free controls. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CI) for PCa associated with warfarin and DOAC use, adjusted for marital status, education level, other drug use, and comorbidities. Among 31,591 cases and 156,802 controls, there were 18,522 (9.8%) warfarin and 4,455 (2.4%) DOAC users. Warfarin ever-use was associated with reduced risk of PCa overall (OR 0.92 95% CI 0.88–0.96) as were both past and current use. DOAC use was not associated with PCa risk. For some warfarin exposures, decreased risk was observed for unfavorable PCa (high risk/locally advanced/distant metastatic) but not with favorable PCa (low/intermediate risk). Increased risk of favorable PCa was observed for men whose initial warfarin exposure occurred in the 12 month period before diagnosis (OR 1.39; 95% CI 1.13–1.70). Our findings are consistent with previous publications reporting decreased PCa risk with warfarin exposure. Increased risk of favorable PCa suggests detection bias due to increased prostate specific antigen testing when starting on warfarin. Decreased overall PCa risk could reflect bias due to reduced biopsy rates among long-term warfarin users.
- Published
- 2020
14. Association Between Antidiabetic Medications and Prostate-Specific Antigen Levels and Biopsy Results
- Author
-
Anna Lantz, Hans Garmo, Danielle Crawley, Tobias Nordström, Markus Aly, Martin Eklund, Henrik Olsson, Kerri Beckmann, Noor Binti Abd Jalal, Mieke Van Hemelrijck, Jan Adolfsson, Beckmann, Kerri, Crawley, Danielle, Nordström, Tobias, Aly, Markus, Olsson, Henrik, Lantz, Anna, Binti Abd Jalal, Noor, Garmo, Hans, Adolfsson, Jan, Eklund, Martin, and Van Hemelrijck, Mieke
- Subjects
Adult ,Male ,medicine.medical_specialty ,Prostate biopsy ,Biopsy ,Population ,Lower risk ,Rate ratio ,Cohort Studies ,Prostate cancer ,Prostate ,Internal medicine ,cancer-risk ,Diabetes Mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Genetic Predisposition to Disease ,Registries ,education ,Aged ,Sweden ,education.field_of_study ,Marital Status ,medicine.diagnostic_test ,business.industry ,Prostatic Neoplasms ,General Medicine ,Odds ratio ,Middle Aged ,Prostate-Specific Antigen ,medicine.disease ,Metformin ,Prostate-specific antigen ,Sulfonylurea Compounds ,medicine.anatomical_structure ,Case-Control Studies ,Educational Status ,business ,antidiabetic medication ,diabetes-mellitus - Abstract
Importance: Diabetic men appear to have a lower risk of prostate cancer. Whether antidiabetic medications are protective or potentially mask prostate cancer by lowering prostate-specific antigen (PSA) levels is unclear. Objective: To examine the associations of antidiabetic medication use with (1) PSA levels, (2) frequency of PSA testing, (3) receipt of biopsy following elevated PSA results, and (4) prostate cancer detection at biopsy. Design, Setting, and Participants: Population-based cohort study using data from the Stockholm PSA and Biopsy Register. Participants were all prostate cancer-free men aged 40 to 79 years residing in Stockholm County, Sweden, between January 1, 2006, and December 31, 2015. Data were analyzed from November 2018 to March 2019. Exposures: One or more prescription for metformin, sulfonylurea, or insulin, as recorded in Sweden's National Prescribed Drug Register. Main Outcomes and Measures: Levels of PSA following first exposure to antidiabetic medications were assessed using multivariable linear regression. Frequency of PSA testing was assessed via multivariable Poisson regression. Biopsy following elevated PSA (≥3.0 ng/mL) and prostate cancer detection at biopsy were assessed via multivariable logistic regression. Results: The cohort of 564 666 men (median [range] age, 65 [40-79] years) consisted of 4583 men initially exposed to metformin, 1104 exposed to sulfonylurea, and 978 exposed to insulin who were age matched with unexposed men (1:5). Exposed men had lower median (interquartile range) PSA levels before starting antidiabetic medications compared with unexposed men (1.2 [0.7-2.5] vs 1.6 [0.8-3.2] ng/mL). After accounting for baseline differences, PSA levels did not vary from those of unexposed men following exposure to antidiabetic medications. Frequency of PSA testing was higher for those receiving metformin (rate ratio, 1.07; 95% CI, 1.06-1.09) and sulfonylurea (rate ratio, 1.06; 95% CI, 1.03-1.08) but was lower for those receiving insulin (rate ratio, 0.79; 95% CI, 0.77- 0.81). Likelihood of biopsy after elevated PSA was lower among men receiving metformin (odds ratio, 0.87; 95% CI, 0.80-0.96) and insulin (odds ratio, 0.83; 95% CI, 0.74-0.93). There were no differences in prostate cancer detection at biopsy, regardless of PSA levels that triggered the biopsy. Conclusions and Relevance: 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. 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. Refereed/Peer-reviewed
- Published
- 2019
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.