Colao A, Marzullo P, Spiezia S, Giaccio A, Ferone D, Cerbone G, Di Sarno A, Lombardi G
Department of Clinical and Molecular Endocrinology and Oncology, Federico II University of Naples, Italy.
J Clin Endocrinol Metab. 2000 Oct;85(10):3754-61. doi: 10.1210/jcem.85.10.6907.
The insulin-like growth factors (IGFs) have mitogenic effects on normal and tumoral prostate epithelial cells and have been suggested to be involved in prostate cancer. Moreover, chronic GH and IGF-I excess causes prostate overgrowth in patients with acromegaly. This study was designed to investigate whether the suppression of GH and IGF-I levels by surgery or pharmacotherapy could induce the regression of prostatic hyperplasia in acromegalic patients. To this end, prostate volume (PV) as well as the occurrence of prostatic diseases were studied by transrectal ultrasonography in 23 untreated acromegalic patients (with elevated GH and IGF levels). None of the patients reported symptoms due to prostatic disorders or obstruction. At study entry, prostate hyperplasia was found in half patients. After 2 yr, GH, IGF-I, and IGFBP-3 levels were decreased, whereas prostate-specific antigen levels did not change. PV was decreased in the 16 patients who were well controlled. Among the 6 patients with prostate hyperplasia at study entry who achieved disease control, 4 regained a normal PV at the end of the 2 yr of treatment, whereas none of the 5 patients with prostate hyperplasia at study entry and not achieving disease control normalized their PV. When patients were divided according to age, prostate volume decreased after 2 yr only in the 8 controlled patients aged below 50 yr, but not in those controlled and with age above 50 yr despite similar decrease in GH, IGF-I, and IGFBP3 levels. No clinical, transrectal ultrasonography, or cytological evidence of prostate cancer was detected during the study period. These data suggest that hyperplasia, but not cancer, is frequent in acromegalic men, and that the GH-IGF axis and age are independently associated with the development of this process.
胰岛素样生长因子（IGFs）对正常和肿瘤性前列腺上皮细胞具有促有丝分裂作用，并被认为与前列腺癌有关。此外，生长激素（GH）和IGF-I长期过量会导致肢端肥大症患者前列腺过度生长。本研究旨在调查手术或药物治疗对GH和IGF-I水平的抑制是否能促使肢端肥大症患者的前列腺增生消退。为此，通过经直肠超声检查研究了23例未经治疗的肢端肥大症患者（GH和IGF水平升高）的前列腺体积（PV）以及前列腺疾病的发生情况。所有患者均未报告因前列腺疾病或梗阻引起的症状。研究开始时，半数患者发现有前列腺增生。2年后，GH、IGF-I和IGFBP-3水平下降，而前列腺特异性抗原水平未改变。16例病情得到良好控制的患者PV下降。在研究开始时患有前列腺增生且病情得到控制的6例患者中，4例在治疗2年后PV恢复正常，而研究开始时患有前列腺增生且病情未得到控制的5例患者中，无一例PV恢复正常。当根据年龄对患者进行分组时，2年后仅8例年龄低于50岁且病情得到控制的患者前列腺体积减小，而年龄高于50岁且病情得到控制的患者前列腺体积未减小，尽管他们的GH、IGF-I和IGFBP3水平下降程度相似。在研究期间未检测到前列腺癌的临床、经直肠超声或细胞学证据。这些数据表明，增生而非癌症在肢端肥大症男性中很常见，并且GH-IGF轴和年龄与这一过程的发展独立相关。
