Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Eur Urol Focus. 2024 Jul;10(4):641-647. doi: 10.1016/j.euf.2023.10.015. Epub 2023 Oct 27.
Inflammation has been linked to the development of benign prostatic hyperplasia (BPH). SRD5A2 is a pivotal enzyme in the development and growth of the prostate gland and a critical target for BPH therapy. TNF-α regulates epigenetic changes in SRD5A2, leading to suppression of SRD5A2 gene and protein expression. It is unknown whether TNF-α inhibitor therapy affects prostate growth.
To evaluate the effect of TNF-α inhibitor therapy on prostate growth via analysis of measurements on serial pelvic imaging scans.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, we analyzed serial pelvic cross-sectional imaging (magnetic resonance imaging or computed tomography scans) for men aged ≥18 yr receiving TNF-α inhibitors. Our inclusion/exclusion criteria yielded a treatment cohort of 99 men. An age-matched cohort was constructed with the same inclusion/exclusion criteria but without TNF-α therapy (n = 99).
Prostate growth on serial pelvic cross-sectional imaging was the primary outcome measure.
There was no significant difference in total prostate volume (TPV) at baseline between the two groups. The TNF-α treatment group had a lower mean TPV on follow-up (26.21 ± 9.43 vs 32.71 ± 18.89 cm; p = 0.002) and a lower median prostate growth rate (-0.01 vs 0.68 cm/yr; p = 0.001). A multivariable linear regression model adjusted for age, race, initial TPV, and body mass index also revealed a significantly lower growth rate for men in the treatment group.
TNF-α inhibitor use was negatively correlated with the prostate growth rate, suggesting that inflammatory mediators regulate prostate growth.
We examined prostate growth rates in men taking TNF-α inhibitors and found that these drugs have a shrinking effect on the prostate. We conclude that TNF-α inhibitors may impede prostate growth.
炎症与良性前列腺增生（BPH）的发展有关。SRD5A2 是前列腺发育和生长的关键酶，也是 BPH 治疗的关键靶点。TNF-α 调节 SRD5A2 的表观遗传变化，导致 SRD5A2 基因和蛋白表达受到抑制。目前尚不清楚 TNF-α 抑制剂治疗是否会影响前列腺生长。
通过分析系列盆腔影像学扫描的测量值，评估 TNF-α 抑制剂治疗对前列腺生长的影响。
设计、地点和参与者：在这项回顾性队列研究中，我们分析了接受 TNF-α 抑制剂治疗的年龄≥18 岁男性的系列盆腔横断面成像（磁共振成像或计算机断层扫描）。我们的纳入/排除标准产生了一个治疗队列，其中有 99 名男性。根据相同的纳入/排除标准，构建了一个年龄匹配的队列，但没有 TNF-α 治疗（n=99）。
连续盆腔横断面成像上的前列腺生长是主要的结局测量。
两组患者的基线总前列腺体积（TPV）无显著差异。TNF-α 治疗组的随访 TPV 平均值较低（26.21±9.43 vs 32.71±18.89 cm；p=0.002），中位前列腺生长率较低（-0.01 与 0.68 cm/yr；p=0.001）。调整年龄、种族、初始 TPV 和体重指数的多变量线性回归模型也显示治疗组男性的生长率明显较低。
TNF-α 抑制剂的使用与前列腺生长率呈负相关，表明炎症介质调节前列腺生长。
我们检查了服用 TNF-α 抑制剂的男性的前列腺生长率，发现这些药物对前列腺有收缩作用。我们得出结论，TNF-α 抑制剂可能会阻碍前列腺生长。
