• Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA. Eric.Miller2@nih.gov.
• Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.

PURPOSE: Men with diabetes have been found to have a reduced risk of prostate cancer (PCa), potentially due to detection bias from lower prostate-specific antigen (PSA) levels or inhibition of tumor growth. Understanding if lower PCa rates are due to a lower risk of the disease or a detection bias from PSA testing can help inform the benefits and harms from prostate cancer screening.

METHODS: We used data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial to assess the impact of PSA screening on PCa in men with diabetes and the potential role of detection bias and/or slower tumor growth. Comparing men by diabetes status, we calculated age-adjusted incidence rates by tumor grade and compared screening results, PSA levels, and tumor characteristics.

RESULTS: Men with diabetes had lower rates of PCa but was limited to low- and intermediate-grade tumors. Men with diabetes were less likely to be biopsied after their first positive screening test and men diagnosed with low/intermediate-grade tumors had significantly more advanced tumors with higher PSA levels.

CONCLUSIONS: Our findings provide additional evidence that detection bias is likely contributing to the lower rates of low- and intermediate-grade prostate cancers.