Ana Paula Pagano, Bruna Ramos da Silva, Flávio Teixeira Vieira, Luiz Fernando Meira Filho, Sarah A Purcell, John D Lewis, Michelle L Mackenzie, Paula J Robson, Jennifer E Vena, Flávia Moraes Silva, Carla M Prado
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Cohort and case-control studies that assessed PC risk in adult males (≥18 years) associated with type 2 diabetes mellitus or diabetes (if there was no distinction between diabetes type) were included. The Newcastle-Ottawa Scale (NOS) was used to assess study bias; those with NOS<7 were excluded. Evidence certainty was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.</p><p><strong>Results: </strong>Thirty-four studies (n=26 cohorts and n=8 case-controls) were included. Of these, 32 assessed diabetes and all PC stages combined, 12 included early PC stages, and 15 included advanced PC stages. Our meta-analysis showed diabetes had a protective effect against early PC development (n=11, risk ratio [RR]=0.71; 95% confidence interval [CI]=0.61-0.83, I²=84%) but no association was found for combined (n=21, RR=0.95; 95% CI=0.79-1.13, I²=99%) or advanced PC stages (n=15, RR=0.96; 95% CI=0.77-1.18, I²=98%) at diagnosis. According to GRADE, the evidence certainty was very low.</p><p><strong>Conclusions: </strong>Diabetes may be protective against early PC stages, yet evidence linking diabetes to risk across all stages, and advanced PC specifically, is less conclusive. High heterogeneity may partially explain discrepancy in findings and was mostly associated with study design, method used for PC diagnosis, and risk measures. Our results may aid risk stratification of males with diabetes and inform new approaches for PC screening in this group, especially considering the reduced sensitivity of prostate-specific antigen values for those with diabetes.</p>","PeriodicalId":54261,"journal":{"name":"World Journal of Mens Health","volume":" ","pages":""},"PeriodicalIF":4.0000,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association Between Diabetes and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis of Observational Studies.\",\"authors\":\"Ana Paula Pagano, Bruna Ramos da Silva, Flávio Teixeira Vieira, Luiz Fernando Meira Filho, Sarah A Purcell, John D Lewis, Michelle L Mackenzie, Paula J Robson, Jennifer E Vena, Flávia Moraes Silva, Carla M Prado\",\"doi\":\"10.5534/wjmh.240022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Metabolic diseases such as diabetes mellitus may play a role in the development and progression of prostate cancer (PC); however, this association remains to be explored in the context of specific PC stages. 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Our results may aid risk stratification of males with diabetes and inform new approaches for PC screening in this group, especially considering the reduced sensitivity of prostate-specific antigen values for those with diabetes.</p>\",\"PeriodicalId\":54261,\"journal\":{\"name\":\"World Journal of Mens Health\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Mens Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5534/wjmh.240022\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANDROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Mens Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5534/wjmh.240022","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANDROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：糖尿病等代谢性疾病可能会在前列腺癌（PC）的发生和发展过程中发挥作用；然而，这种关联性仍有待在特定 PC 阶段的背景下进行探讨。本研究旨在系统回顾糖尿病与前列腺癌总体、早期或晚期风险之间相关性的证据：从开始到 2023 年 9 月，我们进行了系统性综述和荟萃分析（MEDLINE、EMBASE 和 CINAHL）。研究纳入了评估与 2 型糖尿病或糖尿病（如果没有区分糖尿病类型）相关的成年男性（≥18 岁）PC 风险的队列研究和病例对照研究。采用纽卡斯尔-渥太华量表（NOS）评估研究偏倚；结果显示，有NOS的研究有偏倚：共纳入 34 项研究（26 项队列研究和 8 项病例对照研究）。其中，32 项研究合并评估了糖尿病和所有 PC 阶段，12 项研究包括早期 PC 阶段，15 项研究包括晚期 PC 阶段。我们的荟萃分析表明，糖尿病对早期PC的发展具有保护作用（n=11，风险比[RR]=0.71；95%置信区间[CI]=0.61-0.83，I²=84%），但与诊断时的合并期（n=21，RR=0.95；95% CI=0.79-1.13，I²=99%）或晚期PC期（n=15，RR=0.96；95% CI=0.77-1.18，I²=98%）没有关联。根据GRADE，证据确定性很低：糖尿病可能对早期 PC 具有保护作用，但将糖尿病与所有阶段的风险，特别是晚期 PC 的风险联系起来的证据却不那么确凿。高度异质性可能是研究结果差异的部分原因，主要与研究设计、PC诊断方法和风险测量有关。我们的研究结果可能有助于对男性糖尿病患者进行风险分层，并为这一群体的PC筛查提供新方法，特别是考虑到前列腺特异性抗原值对糖尿病患者的敏感性降低。
Association Between Diabetes and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis of Observational Studies.
Purpose: Metabolic diseases such as diabetes mellitus may play a role in the development and progression of prostate cancer (PC); however, this association remains to be explored in the context of specific PC stages. The objective of this study was to systematically review the evidence for an association between diabetes and overall, early, or advanced PC risk.
Materials and methods: A systematic review with meta-analysis was performed (MEDLINE, EMBASE, and CINAHL) from inception until September 2023. Cohort and case-control studies that assessed PC risk in adult males (≥18 years) associated with type 2 diabetes mellitus or diabetes (if there was no distinction between diabetes type) were included. The Newcastle-Ottawa Scale (NOS) was used to assess study bias; those with NOS<7 were excluded. Evidence certainty was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.
Results: Thirty-four studies (n=26 cohorts and n=8 case-controls) were included. Of these, 32 assessed diabetes and all PC stages combined, 12 included early PC stages, and 15 included advanced PC stages. Our meta-analysis showed diabetes had a protective effect against early PC development (n=11, risk ratio [RR]=0.71; 95% confidence interval [CI]=0.61-0.83, I²=84%) but no association was found for combined (n=21, RR=0.95; 95% CI=0.79-1.13, I²=99%) or advanced PC stages (n=15, RR=0.96; 95% CI=0.77-1.18, I²=98%) at diagnosis. According to GRADE, the evidence certainty was very low.
Conclusions: Diabetes may be protective against early PC stages, yet evidence linking diabetes to risk across all stages, and advanced PC specifically, is less conclusive. High heterogeneity may partially explain discrepancy in findings and was mostly associated with study design, method used for PC diagnosis, and risk measures. Our results may aid risk stratification of males with diabetes and inform new approaches for PC screening in this group, especially considering the reduced sensitivity of prostate-specific antigen values for those with diabetes.
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