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Diabetes and Acute Care Use Among Patients With Metastatic Prostate Cancer Treated With Androgen Receptor Signaling

Michael A Liu1, Rohit Raghunathan1, Karie Runcie1

  • 1Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY.

JCO Oncology Practice
|June 12, 2025
PubMed
Abstract

Insights

Older prostate cancer patients with diabetes on androgen receptor signaling inhibitors (ARSIs) experienced higher acute care use. This highlights a need for interventions to manage ARSI side effects in diabetic patients.

Area of Science:

  • Oncology
  • Geriatrics
  • Pharmacology

Background:

  • Androgen receptor signaling inhibitors (ARSIs) are crucial for metastatic prostate cancer treatment.
  • Hyperglycemia is a known side effect of ARSIs, but data on acute care utilization are limited.
  • Understanding the impact of diabetes on acute care use in patients on ARSIs is essential for optimizing patient outcomes.

Purpose of the Study:

  • To evaluate the association between diabetes and acute care use in elderly patients with metastatic prostate cancer receiving ARSIs.
  • To compare acute care utilization rates between diabetic and non-diabetic patients on ARSIs.

Main Methods:

  • Utilized SEER-Medicare data for patients aged 66+ with de novo metastatic prostate cancer initiated on abiraterone, enzalutamide, or apalutamide (2010-2017).
  • Employed negative binomial regression to calculate incidence rate ratios (IRRs) for acute care use.
  • Analyzed total hospital or emergency admissions relative to total time at risk.

Main Results:

  • The study included 2,697 patients; 17.4% had diabetes.
  • Diabetic patients showed significantly higher acute care use within 6 months (39.9%) compared to non-diabetic patients (27.4%).
  • Patients with diabetes had an increased rate of acute care use (IRR=1.38; P=.003), and abiraterone users had higher acute care use (IRR=1.43; P=.005) compared to enzalutamide/apalutamide users.

Conclusions:

  • Acute care use is frequent in metastatic prostate cancer patients treated with ARSIs.
  • Diabetes is associated with elevated rates of acute care use among patients on ARSIs.
  • Further research into interventions for older diabetic patients on ARSIs is warranted.

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