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Editor's Correspondence |

Relation Between Duration of Androgen Deprivation Therapy and Degree of Insulin Resistance in Men With Prostate Cancer

Shehzad Basaria, MD; Denis C. Muller, MS; Michael A. Carducci, MD; Josephine Egan, MD; Adrian S. Dobs, MD
Arch Intern Med. 2007;167(6):612-613. doi:10.1001/archinte.167.6.612.
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Prostate cancer is one of the most common cancers in men. Androgen deprivation therapy (ADT) is frequently used in patients with recurrent or metastatic prostate cancer. Although ADT improves survival in a subset of patients, these men develop profound hypogonadism resulting in decreased lean body mass, decreased muscle strength, decreased quality of life, increased fat mass, sexual dysfunction, and osteoporosis.1 Though less appreciated, these men also develop metabolic abnormalities. Within 3 months of initiation of ADT, these men develop significant hyperinsulinemia; however, there is no change in fasting glucose levels.2 To the contrary, long-term ADT is not only associated with insulin resistance, but also with hyperglycemia and metabolic syndrome.3,4 We have recently shown a significantly higher prevalence of insulin resistance, hyperglycemia, and metabolic syndrome in men with prostate cancer undergoing long-term ADT (ADT group) compared with the following 2 groups: (1) men with prostate cancer who had undergone local surgery and/or radiation but were not androgen deprived (and were eugonadal) (non-ADT group) and (2) age-matched healthy eugonadal men (controls).3,4 These findings suggest that hypogonadism may be the inciting factor in the development of these complications, though prospective studies are needed to confirm these findings. These complications of ADT are surfacing at a time when cardiovascular diseases have become the single most common cause of mortality in this patient population.5 Although it is known that men receiving ADT have metabolic abnormalities, it is unknown whether the duration of ADT is related to the severity of these perturbations.

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Figure.

Correlation between the duration of androgen deprivation therapy, (ADT) and waist circumference (R2 = 0.53, P<.01) (A), fasting glucose (FPG) (R2 = 0.23, P = .04) (B); fasting insulin (R2 = 0.14, P = .13) (C), and homeostatic model assessment for insulin resistance (HOMAIR) (R2 = 0.25; P = .03) (D). To convert waist circumference to centimeters, multiply by 2.54; to convert glucose to millimoles per liter, multiply by 0.0555; to convert insulin to picomoles per liter, multiply by 6.945.

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