Endocrine patterns in patients with benign and malignant prostatic diseases

BACKGROUND The known importance of the endocrine system, particularly of steroid hormones, for development of the prostate gland and the fact that steroid hormones act as immunmodulators prompted us to compare hypophyseal, adrenal, and gonadal hormones, including cortisol, in patients with benign and malignant prostatic diseases. METHODS Patients with newly diagnosed, untreated prostate cancer (PC) (n = 75) and, as a control population, those with untreated lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) (n = 159) entered this prospective study. In all patients, the following parameters were obtained by serum analysis: prostate-specific antigen (PSA), human luteinizing hormone (hLH), human follicle-stimulating hormone (hFSH), testosterone, estradiol (E2), cortisol, and dehydroepiandrosterone-sulphate (DHEA-S). Serum samples were collected of fasting patients between 7.30–10.00 AM. RESULTS Age was comparable in both groups (PC: 65.6 ± 7.6 years (mean ± standard deviation) vs. controls: 64.9 ± 8.1 years; P = 0.56). HFSH (PC: 6.6 ± 3.9 mIU/ml; controls: 8.4 ± 6.4 mIU/ml; P = 0.04), hLH (PC: 5.3 ± 4.8mIU/ml; controls: 7.6 ± 6.2 mIU/ml; P = 0.009), and estradiol (PC: 25.8 ± 12.7 pg/ml; controls: 32.6 ± 12.6 pg/ml; P = 0.0003) were significantly lower in PC patients than controls. Cortisol (PC: 16.7 ± 4.2 μg/dl; controls: 13.5 ± 4.3 μg/dl; P < 0.0001) was significantly higher in cases. The difference for cortisol and estradiol concentrations between PC patients and controls held true in all life-decades. Serum concentrations for DHEA-S and testosterone were comparable between PC and control patients. In PC patients, none of the endocrine parameters correlated to serum PSA or clinical/pathological stage. CONCLUSIONS Patients with newly diagnosed, untreated PC yielded significantly higher cortisol and lower estradiol serum concentrations than controls. The known effect of cortisol on the immune status warrants further studies. Prostate 44:219–224, 2000. © 2000 Wiley-Liss, Inc.