Diabetes and Prostate Cancer Aggressiveness at Diagnosis and Progression in White Americans and Black Americans from the North Carolina-Louisiana Prostate Cancer Project (PCaP)

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  • March 21, 2019
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  • Khan, Saira
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Epidemiological studies have established that diabetes is protective against incident prostate cancer (CaP). However, the existing literature on the association of diabetes with CaP aggressiveness at diagnosis and progression is inconsistent, and research in racially diverse cohorts is limited. The goal of this dissertation was to examine the relationship between diabetes and CaP in cohort of men with incident CaP from the North Carolina-Louisiana Prostate Cancer Project (PCaP), a population-based cohort of White Americans (Whites) and Black Americans (Blacks). Follow-up data for North Carolina participants was available from the Health Care Access and Prostate Cancer Treatment in North Carolina (HCaP-NC) cohort for on average 5 years after CaP diagnosis. Specific aim 1 sought to assess the association between diabetes and CaP aggressiveness at diagnosis in Black and White participants in PCaP. High aggressive CaP was defined as Gleason sum ≥8, or prostate specific antigen >20 ng/ml, or Gleason sum =7 and clinical stage cT3-cT4. We found that diabetes was not associated with high aggressive CaP in the overall cohort (OR: 1.04; 95% CI: 0.79, 1.37), Whites (OR: 1.00; 95% CI: 0.65, 1.57), or Blacks (OR: 1.07; 95% CI: 0.75, 1.53). Specific aim 2 sought to implement a CaP progression algorithm and to assess the association between diabetes and CaP progression in Black and White participants in HCaP-NC. 20.9% of HCaP-NC participants experienced CaP progression. Progression was more prevalent in Blacks (25.0%) than Whites (17.6%). Diabetes was not associated with CaP progression in the cohort as a whole (HR: 0.86, 95%CI: 0.54, 1.35), Whites (HR: 1.03, 95%CI: 0.50, 2.13), or Blacks (HR: 0.77, 95% CI: 0.43, 1.39). Although obesity was not part of our primary aims, given the close relationship between obesity and diabetes we also examined the association of obesity, independent of diabetes, with CaP aggressiveness and CaP progression. Obesity, independent of diabetes, was positively associated with high aggressive CaP in Whites only (OR: 1.98; 95% CI: 1.14, 3.43). No association was observed in Blacks or the cohort as whole. Similarly, obesity, independent of diabetes, was associated with CaP progression (HR: 1.79, 95% CI: 1.08, 2.97) in Whites only.
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  • In Copyright
Advisor
  • Cai, Jianwen
  • Nielsen, Matthew
  • Bensen, Jeannette
  • Troester, Melissa
  • Olshan, Andrew
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016
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