Impact of metformin on serum prostate-specific antigen levels: Data from the national health and nutrition examination survey 2007 to 2008

Purpose: A possible association between metformin use and the development of prostate cancer (PCa) has been reported. However, there is limited information on the impact of long-term metformin use on serum prostate-specific antigen (PSA) levels. We investigated the association between exposure to metformin and PSA levels among diabetic patients who were not previously diagnosed with PCa. Methods: The analytic sample consisted of 1363 US men aged above 40 in the National Health and Nutrition Examination Survey 2007 to 2008 cycle. Men who had previous diagnoses of PCa or prostatitis and men exposed to manipulations that might have affected PSA levels were excluded. Multivariate logistic regression analyses were used to evaluate the association between PSA levels and metformin use by adjusting for potential confounders. Results: The mean PSA level of the overall population was 1.8 (standard deviation=3.1)ng/mL. There were no differences in PSA levels according to the presence of diabetes (P=.517). Among patients with diabetes, metformin users exhibited significantly lower PSA levels compared with nonmetformin users (odds ratio=0.790; 95% confidence interval 0.666-0.938; P=.007). However, no significant difference was found in PSA levels among men over duration of metformin use when levels were stratified by either 1 year or 5 years by Pearson's coefficient. Conclusion: A negative association between serum PSA levels and metformin use was observed in patients with diabetes. Duration of metformin use did not influence PSA levels. Further studies are warranted to elucidate whether the reduction in PSA level with metformin truly reflects reduced risk of PCa development and progression.