Effects of Growth Hormone (GH) and Insulin-Like Growth Factor 1 on Prostate Disease: An Ultrasonographic and Endocrine Study in Acromegaly, GH Deficiency, and Healthy Subjects
The role of insulin-like growth factor 1 (IGF-1) in prostate development is currently under thorough investigation because it has been claimed that IGF-1 is a positive predictor of prostate cancer. To assess the effect of GH and IGF-1 levels on prostate pathophysiology, 46 acromegalic (30 in active disease, ten cured from acromegaly, and six affected from GH deficiency) and 30 aged-matched male controls, free from previous or concomitant prostate disorders, underwent pituitary, androgen, and prostate hormonal assessments and transrectal ultrasonography. Compared to control values, GH (P<0.0001), IGF-1 (P<0.0001), and IGFBP-3 (P<0.001) levels were increased, whereas testosterone (P<0.0001) and dihydrotestosterone levels (P<0.0001) were reduced in active acromegalic patients. Hypogonadism was present in 28 of the 46 acromegalic patients (60.8%). The anteroposterior (P<0.05), and transverse (P<0.0001) prostate diameters and the transitional zone volume (P<0.05) were increased in acromegalic patients compared to those in controls. Prostate volume (PV) was significantly higher in untreated acromegalic patients than in controls (41.7 3.2 vs. 21.9 1.4 mL; P<0.0001), cured patients (23.6 1.6 mL; P<0.0001), and GH-deficient patients (17.5 1.1 mL; P<0.0001). In the patients, PV was correlated with disease duration (r=0.606; P<0.0001) and age (r=0.496; P<0.0001), whereas in controls it was correlated with age (r=0.476; P<0.01) and IGF-1 levels (r=-0.448; P<0.05). Benign prostate hyperplasia (PV > 30 mL) was found in 58% of the acromegalics and 26.6% of the controls. When grouped by age (<40, 40-60, and >60 yr), PV was increased in elderly patients compared to younger patients (P<0.05) and to controls (P<0.01). The prevalence of structural abnormalities, including calcifications, nodules, cysts, and vesicle inflammation, was significantly increased in patients compared to controls (78.2% vs. 23.3%; x2= 5.856; P<0.05). No clinical, transrectal ultrasonography, or cytological evidence of prostate cancer was detected in acromegalic or control subjects. In conclusion, chronic excess of GH and IGF-1 cause prostate overgrowth and further phenomena of rearrangement, but not prostate cancer.
Journal of the Clinical Endocrinology & Metabolism
AnnaMarie Colao, Paolo Marzullo, Stefano Spiezia, Diego Ferone,
Assunta Giaccio, Gaetana Cerbone, Rosario Pivonello, Carolina Di Somma,
and Gaetano Lombardi March 8, 1999, Vol. 84, No. 6
