This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Colao, A. Articles by Lombardi, G. Search for Related Content PubMed PubMed Citation Articles by Colao, A. Articles by Lombardi, G.

Effect of Growth Hormone (GH) and/or Testosterone Replacement on the Prostate in GH-Deficient Adult Patients

Department of Clinical and Molecular Endocrinology and Oncology (A.C., C.D.S., M.F., R.P., G.L.), "Federico II" University of Naples; and Echo-Guided Surgery Unit, "Santa Maria del Popolo degli Incurabili" Hospital of Naples (S.S.), 80131 Naples, Italy

Address all correspondence and requests for reprints to: Annamaria Colao, M.D., Ph.D., Department of Molecular and Clinical Endocrinology and Oncology, University "Federico II" of Naples, Via Sergio Pansini 5, 80131 Naples, Italy. E-mail: colao{at}unina.it.

The prostate is a target organ of the GH and IGF-I axis because prostate hypertrophy is found in acromegaly, reduced prostate size is found in GH deficiency (GHD) patients, and additionally, IGF-I is reported to be a positive predictor factor of prostate cancer.

To investigate whether GH replacement therapy in adult patients with GHD has adverse effects on the prostate, we studied the effect of 12-month GH or GH plus testosterone replacement on prostate pathophysiology in 24 adult patients with GHD (11 euandrogenemic and 13 hypoandrogenemic), compared with 24 age-matched healthy controls.

At study entry, GHD patients had lower prostate volume than controls (19.4 ± 1.7 vs. 24.9 ± 1.7 ml; P = 0.03). After 12 months of treatment, all hypoandrogenemic patients achieved normal testosterone levels, and prostate volume increased in the patients to the same level as controls (25.0 ± 1.9 ml). The percentage increase in prostate volume was greater in hypoandrogenemic patients receiving both GH and testosterone replacement (51 ± 11%) than in those receiving GH replacement alone (15 ± 3%; P < 0.0009). At baseline, prostate volume was similar in GHD patients below or above 60 yr of age (16.8 ± 1.3 vs. 23 ± 3.6 ml; P = 0.08), whereas after treatment it was higher in the latter patients (21.8 ± 1.2 vs. 29.5 ± 3.9 ml; P = 0.04). Prostate-specific antigen (PSA) and free PSA did not change, whereas PSA density was significantly reduced after treatment in hypoandrogenemic patients; there was also no change in calcifications, cysts, or nodules.

In conclusion, GH replacement restores prostate size to normal in both young and elderly patients, with no increase in prostate abnormalities. Because the simultaneous treatment with GH and testosterone induces an increase of prostate size by 50% of baseline on average, care is suggested in elderly patients with prostate hyperplasia to avoid any risk of prostate symptoms. In these cases, GH replacement might be performed sequentially to reduce the hypertrophic effect of combining GH and testosterone.

Abbreviations: APD, Anteroposterior diameter; ARG, arginine; BPH, benign prostate hyperplasia; CCD, craniocaudal diameter; CV, coefficient(s) of variation; DHT, dihydrotestosterone; f-PSA, free PSA; GHD, GH deficiency; IGFBP, IGF binding protein; PRL, prolactin; PSA, prostate-specific antigen; TD, transversal diameter; TRUS, transrectal ultrasonography.

This article has been cited by other articles:

				Z. Wang, R. M. Luque, R. D. Kineman, V. H. Ray, K. T. Christov, D. D. Lantvit, T. Shirai, S. Hedayat, T. G. Unterman, M. C. Bosland, et al. Disruption of Growth Hormone Signaling Retards Prostate Carcinogenesis in the Probasin/TAg Rat Endocrinology, March 1, 2008; 149(3): 1366 - 1376. [Abstract] [Full Text] [PDF]

				G. Minniti, V. Esposito, M. Piccirilli, A. Fratticci, A. Santoro, and M.-L. Jaffrain-Rea Diagnosis and management of pituitary tumours in the elderly: a review based on personal experience and evidence of literature Eur. J. Endocrinol., December 1, 2005; 153(6): 723 - 735. [Abstract] [Full Text] [PDF]

				Z. Wang, G. S. Prins, K. T. Coschigano, J. J. Kopchick, J. E. Green, V. H. Ray, S. Hedayat, K. T. Christov, T. G. Unterman, and S. M. Swanson Disruption of Growth Hormone Signaling Retards Early Stages of Prostate Carcinogenesis in the C3(1)/T Antigen Mouse Endocrinology, December 1, 2005; 146(12): 5188 - 5196. [Abstract] [Full Text] [PDF]

				A. Colao, G. Vitale, A. Di Sarno, S. Spiezia, E. Guerra, A. Ciccarelli, and G. Lombardi Prolactin and Prostate Hypertrophy: A Pilot Observational, Prospective, Case-Control Study in Men with Prolactinoma J. Clin. Endocrinol. Metab., June 1, 2004; 89(6): 2770 - 2775. [Abstract] [Full Text] [PDF]