title: Type of diabetes mellitus and the odds of Gleason score 8 to 10 prostate cancer.
abstract: OBJECTIVE
  It has been recently shown that diabetes mellitus (DM) is significantly associated with the likelihood of presenting with high-grade prostate cancer (PCa) or Gleason score (GS) 8 to 10; however, whether this association holds for both Type 1 and 2 DM is unknown. In this study we evaluated whether DM Type 1, 2, or both are associated with high-grade PCa after adjusting for known predictors of high-grade disease.
  
  
  METHODS
  Between 1991 and 2010, a total of 15,330 men diagnosed with PCa and treated with radiation therapy were analyzed. A polychotomous logistic regression analysis was performed to evaluate whether Type 1 or 2 DM was associated with odds of GS 7 or GS 8 to 10 compared with 6 or lower PCa, adjusting for African American race, age, prostate-specific antigen (PSA) level, and digital rectal examination findings.
  
  
  RESULTS
  Men with Type 1 DM (adjusted odds ratio [AOR], 2.05; 95% confidence interval [CI], 1.28-3.27; p = 0.003) or Type 2 DM (AOR, 1.58; 95% CI, 1.26-1.99; p < 0.001) were significantly more likely to be diagnosed with GS 8 to 10 PCa compared with nondiabetic men. However this was not true for GS 7, for which these respective results were AOR, 1.30; 95% CI, 0.93-1.82; p = 0.12 and AOR, 1.13; 95% CI, 0.98-1.32; p = 0.10.
  
  
  CONCLUSIONS
  Type 1 and 2 DM were associated with a higher odds of being diagnosed with Gleason score 8 to 10 but not 7 PCa. Pending validation, men who are diagnosed with Type I DM with GS 7 or lower should be considered for additional workup to rule out occult high-grade disease.
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women’s Hospital, Department of Radiation Oncology, Boston, MA 02115, USA. jkang3@partners.org
authors.forename: Josephine
authors.initials: J
authors.lastname: Kang
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Yuanye
authors.initials: Y
authors.lastname: Zhang
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Dosoretz
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Katin
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Braccioforte
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Salenius
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016001:Confidence Intervals; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D051517:Digital Rectal Examination; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D016017:Odds Ratio; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000150:complications / Q000208:ethnology / Q000473:pathology*; D012044:Regression Analysis
chemical_list: D017430:Prostate-Specific Antigen