Abstract
Benign prostatic hyperplasia (BPH) represents a pattern of non-malignant growth of prostatic fibromuscular stroma. Metabolic disturbances such us pre-diabetes and metabolic syndrome may have a role in BPH pathophysiology. A potential explanation for the above relationship involves the insulin-like growth factor (IGF) axis as well as IGF binding proteins, (IGFBPs) of which the most abundant form is IGFBP-3. Therefore, the aim of the present study was to investigate the association between intra-prostatic levels of IGF-1, IGF-2 as well as to evaluate the role of locally expressed IGFBP-3 in BPH development in pre-diabetes. A total of 49 patients admitted to the Urology department of a tertiary urban Greek hospital, for transurethral prostate resection, or prostatectomy and with pre-diabetes [impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) or both] were finally included. The majority of the sample consisted of subjects with IGT (51.0%), followed by IFG and IGT (32.7%) and isolated IFG (16.3%). For all participants a clinical examination was performed and blood samples were collected. In addition, total prostate (TP) volume or transitional zone (TZ) volume were estimated by transrectal ultrasonography. The results of the multivariate analysis regarding TP volume showed that higher PSA (p<0.001), larger waist circumference (p=0.007) and higher IGFBP-3 expression levels (p<0.001) independently predicted higher TP volume. The results regarding the volume of the TZ showed that higher PSA (p<0.001), larger waist circumference (p<0.001) and higher IGFBP-3 expression levels (p=0.024) were independently associated with higher TZ volume. Our findings show that intra-prostatic levels of IGFBP-3, PSA and waist circumference, but not overall obesity, are positively associated with prostate volume. IGFBP-3 seems to be a multifunctional protein, which can potentiate or inhibit IGF activity.
Highlights
Benign prostatic hyperplasia (BPH) represents a pattern of unregulated but non-malignant growth of prostatic fibromuscular stroma [1]
The mean age was 71.3±7.3 years; the majority (n=25) of the sample consisted of subjects with impaired glucose tolerance (IGT) (51.0%), followed by impaired fasting glucose (IFG) and IGT 16 (32.7%) and isolated IFG 8 (16.3%). 51% (n=25) of prediabetic subjects had metabolic syndrome (MS) according to the NCEP ATP III criteria
Larger total prostate (TP) volume was associated with higher prostate specific antigen (PSA) levels (r=+0.880, p
Summary
Benign prostatic hyperplasia (BPH) represents a pattern of unregulated but non-malignant growth of prostatic fibromuscular stroma [1]. Hamarsten et al [4], have reported that men with components of MS had significantly larger prostate volumes and BPH growth rates. In this context Nandeesha et al [5], have reported that fasting serum insulin was significantly higher in men with BPH than in controls without BPH and obesity, elevated fasting plasma glucose levels, diabetes, were risk factors for developing benign prostatic hyperplasia [6]
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