title: The impact of diabetes mellitus on survival in men with clinically localized prostate cancer treated with permanent interstitial brachytherapy.
abstract: OBJECTIVE
  Patients with cancer of any origin with preexisting diabetes mellitus (DM) are at increased risk for all-cause mortality compared with those without DM. However, the influence of DM on biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) has not been clearly defined for men with clinically localized prostate cancer treated with brachytherapy.
  
  
  METHODS
  From April 1995 to May 2006, 1624 consecutive patients underwent brachytherapy with or without supplemental therapies. A prebrachytherapy diagnosis of diabetes was present in 199 patients (12.3%). Median follow-up was 7.8 years. Cause of death was determined for each deceased patient. Patients with metastatic prostate cancer or castrate-resistant disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death.
  
  
  RESULTS
  In patients without (n=1425) and with (n=199) DM, CSS was 97.2% versus 100% (P=0.168), bPFS was 95.6% versus 95.7% (P=0.960), and OS was 77.3% versus 56.0% at 12 years (P=0.003). In Cox regression analysis, OS in nondiabetic patients was most closely related to patient age, coronary artery disease, tobacco consumption, and androgen deprivation. In patients with diabetes, OS was related to patient age and coronary artery disease. In patients without diabetes, CSS was associated with Gleason score and clinical stage. No patient with diabetes died of prostate cancer. Patients with DM were more likely to die of cardiovascular disease (17.8% vs. 12.4%, P=0.007).
  
  
  CONCLUSIONS
  DM does not impact CSS or bPFS after brachytherapy. OS is significantly lower in patients with diabetes due to more deaths from cardiovascular disease.
authors: Department of Radiation Oncology, University of Washington, Seattle, WA, USA.
authors: Madhu B
authors: MB
authors: Shetti
authors: Gregory S
authors: GS
authors: Merrick
authors: Wayne M
authors: WM
authors: Butler
authors: Robert
authors: R
authors: Galbreath
authors: Ashley
authors: A
authors: Torlone
authors: Jonathan H
authors: JH
authors: Lief
authors: Edward
authors: E
authors: Adamovich
authors: Kent E
authors: KE
authors: Wallner
mesh_terms: D000367:Age Factors; D000368:Aged; D001918:Brachytherapy; D048909:Diabetes Complications / Q000150:complications*; D018572:Disease-Free Survival; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D010165:Palladium / Q000627:therapeutic use; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000150:complications / Q000473:pathology* / Q000532:radiotherapy*
chemical_list: D007457:Iodine Radioisotopes; D010165:Palladium; D017430:Prostate-Specific Antigen