Pd03-05 Does Insulin Resistance Create a Bigger Prostate? Results From the Reduction by Dutasteride of Prostate Cancer Events (Reduce) Trial

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research & Pathophysiology (PD03)1 May 2024PD03-05 DOES INSULIN RESISTANCE CREATE A BIGGER PROSTATE? RESULTS FROM THE REDUCTION BY DUTASTERIDE OF PROSTATE CANCER EVENTS (REDUCE) TRIAL James P. Daniels, James Mirocha, Renning Zheng, Daniel M. Moreira, and Stephen J. Freedland James P. DanielsJames P. Daniels , James MirochaJames Mirocha , Renning ZhengRenning Zheng , Daniel M. MoreiraDaniel M. Moreira , and Stephen J. FreedlandStephen J. Freedland View All Author Informationhttps://doi.org/10.1097/01.JU.0001009388.01015.e5.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) is common in older men; 50% of men over 50 and 80% of men over 80 experience symptoms due to BPH. There are many proposed factors for the pathophysiology of BPH. Specifically, several studies suggest insulin and insulin resistance as independent risk factors for BPH. We tested if insulin resistance is related to baseline prostate volume (PV) and PV growth over the 4-year REDUCE study. METHODS: A post-hoc analysis of REDUCE was carried out in 2804 men on the placebo arm and 2712 men on the dutasteride arm. REDUCE was a randomized trial of dutasteride for prostate cancer prevention in men aged 50-75 with an elevated PSA and negative pre-study biopsy. PV was verified with transrectal ultrasound performed during prostate biopsy at baseline, and 2- and 4-years after randomization. After stratifying men into placebo and dutasteride groups, we calculated the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Pearson correlation was performed to examine associations between HOMA-IR and PV at baseline, 2 years, and 4 years. Pearson correlation was performed again to examine associations between HOMA-IR and mean change in PV over 2 years and 4 years. RESULTS: In the placebo group, higher HOMA-IR was significantly associated with larger PV at baseline (p=0.02). However, overall associations were modest. Median PV in the lowest HOMA-IR quartile was 40.4 ml vs. 46.3 ml in the highest HOMA-IR quartile. Similar findings were noted in the dutasteride arm (p=0.007) with the lowest HOMA-IR quartile having a median PV of 42.2 ml vs. 45.9 ml in the highest HOMA-IR quartile. However, HOMA-IR was unrelated to change in PV over 2 years or 4 years for both the placebo group and dutasteride group. CONCLUSIONS: In the REDUCE study, greater HOMA-IR (i.e. more insulin resistance) was significantly, but weakly, correlated with higher baseline PV in both the placebo group and dutasteride group. However, HOMA-IR was unrelated to PV change during the study. These data support the biological link between insulin resistance and larger prostate size, but suggest the associations are not clinically relevant. Source of Funding: Dr. Daniels is funded by the NIH grants TL1 DK132768 and U2C DK129496 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e78 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information James P. Daniels More articles by this author James Mirocha More articles by this author Renning Zheng More articles by this author Daniel M. Moreira More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...