The association of metformin use with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study
Metformin has been associated with a reduced incidence of prostate cancer and improved prostate cancer outcomes. However, whether race modifies the association between metformin use and prostate cancer aggressiveness remains uncertain. The association between metformin use and prostate cancer aggressiveness was examined separately in Black Americans (Blacks) and White Americans (Whites).
The study population consisted of 305 Black and 195 White research participants with incident prostate cancer and self-reported diabetes from the North Carolina–Louisiana Prostate Cancer Project. High-aggressive prostate cancer was defined using a composite measure of Gleason sum, prostate-specific antigen, and clinical stage. Multivariable logistic regression was used to assess the association between metformin use and high-aggressive prostate cancer at diagnosis, separately among Whites and Blacks, with adjustment for age, screening history, site, education, insurance, and body mass index.
Metformin use was associated positively with high-aggressive prostate cancer in Blacks (OR 2.01; 95% CI 1.05, 3.83). By contrast, a weak inverse association between metformin use and high-aggressive prostate cancer was found in Whites (OR 0.80, 95% CI 0.34, 1.85).
The association between metformin use and prostate cancer aggressiveness may be modified by race.
KeywordsProstate cancer Metformin Black Americans Aggressiveness PCaP
The North Carolina–Louisiana Prostate Cancer Project (PCaP) is carried out as a collaborative study supported by the Department of Defense contract DAMD 17-03-2-0052. The authors thank the staff, advisory committees, and research subjects participating in the PCaP study for their important contributions. Dr. Khan was supported by the National Cancer Institute Grant T32190194 (PI, Colditz) and Department of Defence Grant PC170130. Drs. Khan and Drake are supported by the Foundation for Barnes-Jewish Hospital and Siteman Cancer Center. This content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institute of Health (NIH).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Research involving animal and human participants
This article does not contain any studies with animals performed by any of the authors.
- 1.Surveillance E, Results E (2017) https://seer.cancer.gov/statfacts/html/prost.html. Accessed 6 Oct 2017
- 2.U.S. Department of Health and Human Services. Diabetes and Americans A (2017) https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=18. Accessed 19 Sept 2017
- 3.Xu J, Murphy SL, Kochanek KD, Arias E (2016) Mortality in the United States, 2015. NCHS Data Brief 267:1–8Google Scholar
- 5.Raval AD, Mattes MD, Madhavan S, Pan X, Wei W, Sambamoorthi U (2016) Association between metformin use and cancer stage at diagnosis among elderly Medicare beneficiaries with preexisting type 2 diabetes mellitus and incident prostate cancer. J Diabetes Res 2016:2656814. https://doi.org/10.1155/2016/2656814 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Khan S, Cai J, Nielsen ME et al (2016) The association of diabetes and obesity with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study. Cancer Causes Control 27(12):1475–1485. https://doi.org/10.1007/s10552-016-0828-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Schroeder JC, Bensen JT, Su LJ et al (2006) The North Carolina-Louisiana Prostate Cancer Project (PCaP): methods and design of a multidisciplinary population-based cohort study of racial differences in prostate cancer outcomes. Prostate 66(11):1162–1176. https://doi.org/10.1002/pros.20449 CrossRefPubMedGoogle Scholar
- 26.Goonesekera SD, Yang MH, Hall SA, Fang SC, Piccolo RS, McKinlay JB (2015) Racial ethnic differences in type 2 diabetes treatment patterns and glycaemic control in the Boston Area Community Health Survey. BMJ Open 5(5):e007375. https://doi.org/10.1136/bmjopen-2014-007375 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Perez A, Elrod S, Sanchez J (2016) A comparison of the use and quality of antidiabetic medication regimens between non-Hispanic Black and white adults with uncontrolled type 2 diabetes in the US: NHANES 2003–2012. Diabetes Educ 42(2):234–242. https://doi.org/10.1177/0145721716628650 CrossRefPubMedGoogle Scholar
- 30.Centers for Disease Control and Prevention. National diabetes statistics report. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed 5 Oct 2017
- 31.Theodorou A, Johnson K, Ward M, Szychowski JA (2011) 2010 drug utilization and cost trends for antidiabetic agents. Am J Pharm Benefits 3:54–61Google Scholar