Scientists find clues as to why prostate cancer is more aggressive in men with diabetes

by Barbara Hewitt on February 5, 2018

Prostate cancer and type 2 diabetes are among the most common diseases in men but new research has found that those with type 2 diabetes are less likely to develop prostate cancer but when they do it is more aggressive.

Scientists from the German Centre for Diabetes Research (DZD) and Tubingen University Hospital found that in affected individuals the androgen receptor and the mitogenic forms of the insulin receptor were more strongly expressed. This could explain why patients with diabetes have a poorer prognosis for prostate cancer.

Prostate Cancer

(By designer491/

Although studies indicate that people with diabetes suffer more frequently from cancer, men with diabetes do not increasingly suffer from prostate cancer. On the contrary, meta-analyses of studies have shown that diabetes patients are less likely to develop this carcinoma but the mortality rate is higher.

This is also confirmed by current research carried out by researchers at the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Zentrum München at the University of Tübingen.

The research team recently analysed the data of patients who had their prostate removed due to cancer. As expected, among them were fewer patients with diabetes than in the general population. However, prostate cancer patients with diabetes were significantly more likely to have metastases in the lymph nodes. In addition, the proportion of patients who are at very high risk according to the guidelines of the National Comprehensive Cancer Network (NCCN) was significantly higher among those with diabetes.

In another study the researchers began to look at how prostate cancer differs in men with and without diabetes and what makes prostate carcinoma in patients with metabolic disease so aggressive.

They analysed 70 tumour samples from patients without diabetes and 59 samples from patients with type 2 diabetes and since male sex hormones (androgens) play an important role in the development of prostate cancer, the scientists investigated the androgen signalling chain.

‘We conducted a gene expression analysis of key proteins and found that in men with diabetes, the androgen receptor (AR) was increased,’ said Dr. Martin Heni, who led the study at the IDM. They found that the signalling pathway mediated by AR was also more strongly activated.

The scientists identified another difference. ‘Insulin receptors of isoform A are increasingly expressed in the prostate carcinomas of patients with diabetes,’ said Dr. Stefan Lutz, first author of the study. These can bind insulin-like growth factors (IGFs). This contributes to increased cell growth and cell division. Normally, adults mainly express the isoform B, which does not bind IGF.

In addition, in patients with diabetes, the steroid biosynthesis in the tumour is also altered. Less protective oestrogen receptor ligands are formed and this further strengthens the androgen signalling pathway in tumours.

Heni said that the research provides new insights into why prostate cancer is so aggressive in men with type 2 diabetes while Professor Arnulf Stenzl, head physician of the Urology Department of Tübingen University Hospital, said that prostate carcinoma in men with type 2 diabetes has a poorer prognosis and must therefore be diagnosed and treated earlier and more comprehensively than prostate cancer in nondiabetics.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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