MON-524 The Impact of SGLT2 Inhibitors on Adverse Genitourinary Effects in Prostate Cancer Survivors With Diabetes

Abstract Disclosure: D. Nudelman: None. M. Galsky: Janssen Research & Development Company, Merck, Seagen, Bristol-Myers Squibb, Gilead Sciences, Pfizer, Inc., Curis, AstraZeneca, Novartis, Abbvie, Janssen Oncology, Genentech, Inc., Bicycle Therapeutics, Dendreon. J. Wisnivesky: Sanofi, PPD, Banook, BioNTech, Regeneron, Axella. A. Leiter: None. Background: Diabetes mellitus (DM) is a significant comorbidity in PC survivors (prevalence ∼20%) and is associated with worse mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are DM drugs that lower glucose and reduce CV risk. SGLT2is reduce glucose reabsorption in the kidneys, inducing glucosuria. Due to this mechanism, they are associated with adverse genitourinary (GU) effects. How SGLT2is are tolerated by PC survivors, who have a high baseline burden of GU symptoms from PC treatments like prostatectomy and radiation therapy (RT), is unknown. We hypothesized that PC survivors with T2DM who received SGLT2is had higher rates of urinary tract infections (UTIs) and incontinence after PC treatment, than those not on SLGT2is. Methods: We retrospectively collected data from our institution’s health records linked to cancer registry data. Patients were included for analysis if they had PC diagnosed from 2005-2020, were treated with RT and/or prostatectomy, and had T2DM on non-insulin medications (based on claims codes). Patients with < 2-year follow-up after primary PC treatment and < 4 months of follow-up after beginning SGLT2is were excluded. We collected data on patient demographics, PC, and DM characteristics. We investigated prevalence of incontinence and UTIs 2 years after PC treatment (to ensure new symptoms were not primary treatment-related). We used descriptive statistics to assess population characteristics and compared groups using chi-square test. Results: 190 patients with PC and DM were analyzed. 40 patients (21%) received SGLT2is and 150 (79%) were on other DM drugs. Median follow-up after PC treatment was 5.2 years. Median age at diagnosis was 67, with similar distribution across patients on SLGT2is and other DM drugs (p=0.6). 33% of the cohort was White, 29% Black, 45% Hispanic, with no significant distribution difference (p=0.2). Most patients had localized disease (75%), followed by regional (20%) and metastatic (5%) at time of PC diagnosis, with no significant differences between groups (p=0.7). For PC treatments, 39% received RT, 57% received prostatectomy, and 4% got both (p=0.5). 10% of patients on SGLT2is and 10% of patients on other DM drugs developed a UTI at least 2 years after PC treatment (p=0.99). Incontinence was observed in 13% of patients receiving SGLT2i and in 17% of patients on other DM drugs (p=0.63). 3 patients (7.5%) receiving SGLT2is discontinued the medication due to GU side effects. Conclusions: In a cohort of PC survivors with T2DM, we found no association between SGLT2is and new adverse GU effects relative to those receiving other DM drugs, indicating SLGT2is are generally well-tolerated in this group. These insights can help make PC survivors make informed decisions about initiating SGLT2is and improve guideline-concordant DM care. Future studies should examine SGLT2i adverse GU effects in larger PC survivor populations. Presentation: Monday, July 14, 2025