Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online February 14, 2008
Diabetes Care 31:930-931, 2008
DOI: 10.2337/dc07-1962
© 2008 by the American Diabetes Association
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Online-Only Appendix
Right arrow All Versions of this Article:
dc07-1962v1
31/5/930    most recent
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fukui, M.
Right arrow Articles by Nakamura, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fukui, M.
Right arrow Articles by Nakamura, N.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Epidemiology/Health Services Research
Original Research

Serum Prostate-Specific Antigen Levels in Men With Type 2 Diabetes

Michiaki Fukui, MD1, Muhei Tanaka, MD1, Mayuko Kadono, MD1, Saeko Imai, PHD2, Goji Hasegawa, MD1, Toshikazu Yoshikawa, MD1 and Naoto Nakamura, MD1

1 Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
2 Department of Clinical Nutrition, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan

Corresponding author: Michiaki Fukui, MD, Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. E-mail: sayarinapm{at}hotmail.com


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 RESEARCH DESIGN AND METHODS--
 RESULTS--
 CONCLUSIONS--
 References
 
OBJECTIVE—The aims of this study were to examine if serum prostate-specific antigen (PSA) levels are lower in men with type 2 diabetes compared with those in healthy men and to investigate what factors may be associated with serum PSA levels in men with type 2 diabetes.

RESEARCH DESIGN AND METHODS—We compared the serum PSA levels in 224 diabetic men with those in 1,293 healthy men and investigated the relationships between serum PSA levels and various variables.

RESULTS—Except for men aged 40–49 years, serum PSA levels were lower in diabetic men than in healthy men. Multiple regression analysis demonstrated that age, BMI, and presence of diabetes were independent determinants of serum PSA level.

CONCLUSIONS—Serum PSA levels were lower in diabetic men compared with those in healthy men, which is in line with previous reports that patients with type 2 diabetes are at a decreased risk of prostate cancer.

Abbreviations: PSA, prostate-specific antigen


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
RESEARCH DESIGN AND METHODS--
 RESULTS--
 CONCLUSIONS--
 References
 
Patients with diabetes have been reported to be at increased risk of numerous cancers, including cancers of the pancreas, liver, and colon (1,2); however, recent studies (3–5) have suggested that men with diabetes are at a decreased risk of prostate cancer. In this study, we examined if serum prostate-specific antigen (PSA) levels are lower in men with type 2 diabetes compared with those in healthy men. Moreover, we investigated the relationships between serum PSA levels and serum androgen concentrations and investigated what factors may be associated with serum PSA levels in men with type 2 diabetes.


   RESEARCH DESIGN AND METHODS—
TOP
 ABSTRACT
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
RESULTS--
 CONCLUSIONS--
 References
 
Serum PSA levels were measured in 1,293 healthy men who underwent general health screening tests and in 224 consecutive Japanese men with type 2 diabetes, aged between 40 and 79 years, recruited from outpatient clinics of Kyoto Prefectural University of Medicine. We excluded the subjects who had evident prostate disease (e.g., prostate cancer, benign prostate hypertrophy, and prostatitis) and subjects whose serum PSA level exceeded 4.0 ng/ml. The number of subjects in the 40–49, 50–59, 60–69, and 70–79 years age-groups were 152, 573, 404, and 164, respectively, among 1,293 healthy men. The number of subjects in the 40–49, 50–59, 60–69, and 70–79 years age-groups were 21, 63, 92, and 48, respectively, among 224 men with type 2 diabetes. We investigated the relationships between serum PSA levels and variables including age, blood pressure, serum lipid concentrations, A1C, BMI, and severity of diabetes complications. Furthermore, we investigated the relationships between serum PSA levels and serum bioavailable testosterone or bioavailable dihydrotestosterone concentrations in a subgroup of 171 randomly selected diabetic patients.

Serum PSA levels (normal range <4.0 ng/ml) were measured by chemiluminescent immunometric assay. Statistical analyses were performed using Stat View software (version 5.0; SAS Institute, Cary, NC). Correlations between serum PSA level and various variables were examined by Pearson's correlation analyses. The following factors were simultaneously considered as independent variables in the multiple regression analysis: age, BMI, A1C, systolic blood pressure, diastolic blood pressure, serum total cholesterol, triglycerides, HDL cholesterol concentration, and presence of diabetes. A P value <0.05 was considered statistically significant. Approval for the study was obtained from the local research ethics committee, and informed consent was obtained from all participants.


   RESULTS—
TOP
 ABSTRACT
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
 RESULTS--
CONCLUSIONS--
 References
 
Clinical characteristics of subjects enrolled in this study are available in an online appendix (available at http://dx.doi.org/10.2337/dc07-1962). Serum PSA levels in healthy men were 0.81 ± 0.49, 0.96 ± 0.69, 1.17 ± 0.81, and 1.24 ± 0.93 ng/ml in the 40–49, 50–59, 60–69, and 70–79 years age-group, respectively. Serum PSA levels in men with type 2 diabetes were 0.86 ± 0.48, 0.86 ± 0.44, 0.98 ± 0.50, and 1.04 ± 0.56 ng/ml in the 40–49, 50–59, 60–69, and 70–79 years age-group, respectively. Except for age-group 40–49 years, serum PSA levels were lower in diabetic men than in healthy men (Fig. 1).


Figure 1
View larger version (13K):
[in this window]
[in a new window]

  		Figure 1— Comparison of serum PSA levels in men with type 2 diabetes (D) and in healthy men (H) with each decade of life between 40 and 79 years old. Data are presented as medians, 25th and 75th percentiles (boxes), and 10th and 90th percentiles (whiskers).

 
A positive correlation was found between serum PSA levels and age (r = 0.153, P = 0.0221), and a negative correlation was found between serum PSA levels and serum triglyceride concentration (r = –0.144, P = 0.0308) in men with type 2 diabetes. Multiple regression analysis demonstrated that age (β = 0.185, P < 0.0001), BMI (β = –0.196, P = 0.0360), and presence of diabetes (β = –0.244, P = 0.0120) were independent determinants of serum PSA levels, although A1C, blood pressure, and serum lipid concentrations were not (see online appendix). No correlation was found between serum PSA levels and serum bioavailable testosterone concentrations (r = –0.001, P = 0.9902) and between serum PSA level and serum bioavailable dihydrotestosterone concentrations (r = 0.080, P = 0.2973) in men with type 2 diabetes. Serum PSA levels did not differ between patients treated with and without insulin or based on the severity of diabetic nephropathy or retinopathy (data not shown).


   CONCLUSIONS—
TOP
 ABSTRACT
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
 RESULTS--
 CONCLUSIONS--
References
 
Androgens have been implicated in prostate tumorigenesis. Men with diabetes have significantly lower serum testosterone concentration than nondiabetic men (6), and this may partially explain their lower risk of prostate cancer. Shaneyfelt et al. (7) reported that men whose serum total testosterone concentration was in the highest quartile were 2.34 times more likely to develop prostate cancer in a meta-analysis. However, Monath et al. (8) reported no association between serum PSA levels and serum testosterone concentration, as is the case in this study. Intraprostatic androgen status may be more important than circulating levels in determining risk of prostate cancer. Velicer et al. (9) demonstrated that diabetic men who used insulin or who had microvascular complications had a lower risk of prostate cancer, suggesting that the association between diabetes and a decreased prostate cancer risk may be limited to those with severe diabetes. However, serum PSA levels did not differ between patients treated with and without insulin in this study. Moreover, no association was found between serum PSA levels and the severity of diabetic nephropathy or retinopathy.

Limitations of this study included the fact that we could not measure serum androgen concentrations in healthy subjects; therefore, we could not compare serum androgen concentrations between healthy and diabetic men. Further studies are needed to assess if the results of this study, which refer only to Japanese men between 40 and 79 years of age, are applicable to other populations. In conclusion, serum PSA levels were lower in patients with type 2 diabetes compared with those in healthy men, which is in line with previous reports that patients with type 2 diabetes are at a decreased risk of prostate cancer.


   Footnotes
 
Published ahead of print at http://care.diabetesjournals.org on 14 February 2008. DOI: 10.2337/dc07-1962.

Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-1962.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

Received for publication October 10, 2007. Accepted for publication January 25, 2008.


   References
TOP
 ABSTRACT
 INTRODUCTION
 RESEARCH DESIGN AND METHODS--
 RESULTS--
 CONCLUSIONS--
 References
 

  1. Everhart J, Wright D: Diabetes mellitus as a risk factor for pancreatic cancer: a meta-analysis. JAMA 273:1605–1609, 1995[Abstract]
  2. Stricker HD, Wylie-Rosett J, Rohan T, Hoover DR, Smoller S, Burk RD, Yu H: the relation of type 2 diabetes and cancer. Diabetes Technol Ther 3:263–274, 2001[Medline]
  3. Weiderpass E, Ye W, Vainio H, Kaaks R, Adami HO: Reduced risk of prostate cancer among patients with diabetes mellitus. Int J Cancer 102:258–261, 2002[Medline]
  4. Rodriguez C, Patel AV, Mondul AM, Jacobs EJ, Thun MJ, Calle EE: Diabetes and risk of prostate cancer in a prospective cohort of US men. Am J Epidemiol 161:147–152, 2005[Abstract/Free Full Text]
  5. Bonovas S, Filioussi K, Tsantes A: Diabetes mellitus and risk of prostate cancer: a meta-analysis. Diabetologia 47:1071–1078, 2004[Medline]
  6. Andersson B, Marin P, Lissner L, Vermeulen A, Bjorntorp P: Testosterone concentrations in women and men with NIDDM. Diabetes Care 17:405–411, 1994[Abstract]
  7. Shaneyfelt T, Husein R, Bubley G, Mantzoros CS: Hormonal predictors of prostate cancer: a meta-analysis. J Clin Oncol 18:847–853, 2000[Abstract/Free Full Text]
  8. Monath JR, McCullough DL, Hart LJ, Jarow JP: Physiologic variations of serum testosterone within the normal range do not affect serum prostate-specific antigen. Urology 46:58–61, 1995[Medline]
  9. Velicer CM, Dublin S, White E: Diabetes and the risk of prostate cancer: the role of diabetes treatment and complications. Prostate Cancer Prostatic Dis 10:46–51, 2007[Medline]

Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Online-Only Appendix
Right arrow All Versions of this Article:
dc07-1962v1
31/5/930    most recent
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fukui, M.
Right arrow Articles by Nakamura, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fukui, M.
Right arrow Articles by Nakamura, N.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum