ABSTRACT
Objective
To assess the impact of metformin on biochemical failure (BF) in localized prostate
cancers (PC) treated with radical prostatectomy or radiation therapy.
Materials and Methods
About 1449 patients undergoing radical prostatectomy (n = 1338, 92.3%) or radiation
therapy (n = 108, 7.5%) for localized PC between July 2007 and January 2020 were evaluated
for metformin use, demographic/oncologic characteristics, and biochemical outcomes.
Androgen deprivation therapy was utilized per NCCN guidelines. BF rates were assessed
overall and at 1, 3, and 5 years. Time to BF was estimated via Kaplan-Meier; logistic
regression and Cox proportionate hazards models were generated to adjust for significant
differences.
Results
Of 1449 patients, 148 (10.2%) utilized metformin at time of diagnosis, while 1,301
(89.8%) did not. Patients on metformin were significantly older, had higher body mass
indexes, and more aggressive disease (Gleason score >7). At a mean ± SD follow-up
of 3.6 ± 2.6 years, patients on metformin were less likely to experience BF at later
timepoints; however, univariate analysis showed no differences at 1, 3, and 5 years.
In multivariate analysis, patients on metformin were significantly less likely to
experience BF at 5 years and overall in both treatment groups. In Cox regression,
metformin was independently associated with a 40% relative risk reduction in BF.
Conclusion
In multivariate analysis, metformin use was associated with a significant risk reduction
in BF overall and at 5 years following primary treatment; this trend was not witnessed
in univariate analysis. This suggests the need for future investigations of metformin's
role in disease-free survival in men with localized PC.
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Article info
Publication history
Published online: January 27, 2021
Footnotes
Conflicts of Interest: The authors have no conflicts of interest to disclose.
Funding: Self-funded.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
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© 2021 Elsevier Inc. All rights reserved.
