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Serum Insulin-Like Growth Factor-I Levels and Prostatic Intraepithelial Neoplasia: A Clue to the Relationship Between IGF-I Physiology and Prostate Cancer Risk

¹ Division of Urology, Sunnybrook and Women's College Health Sciences Centre, ² Division of Urology, Departments of ³ Medical Imaging and ⁴ Pathology, University Health Network, and ⁵ Department of Public Health Sciences, University of Toronto, Toronto; and ⁶ Department of Medical Oncology, McGill University, Quebec, Canada

Requests for reprints: Robert K. Nam, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, MG-406 Toronto, Ontario, Canada, M4N 3M5. Phone: 416-480-5075; Fax: 416-480-6121. E-mail: robert.nam{at}utoronto.ca

Serum insulin-like growth factor-I (IGF-I) levels at the higher end of the reference range have been associated with increased risk for the future development of prostate cancer. We determined whether high serum IGF-I levels are associated with precancerous lesions of the prostate. We conducted a case-control study to determine whether high serum IGF-I levels were associated with the presence of high-grade prostatic intraepithelial neoplasia (HGPIN) among patients who presented for prostate biopsy because of an abnormal serum prostate-specific antigen level or digital rectal exam. We measured serum IGF-I and insulin-like growth factor binding protein-3 (IGFBP-3) prior to prostate biopsy and compared them between 103 men with HGPIN (cases) and 205 men with normal prostate histology (controls). The mean IGF-I level in patients with HGPIN (130.2 ng/mL) was significantly higher compared with controls (118.8 ng/mL, P = 0.01). The mean IGFBP-3 level in patients with HGPIN (2,393.9 ng/mL) was also higher compared with controls (2,276.0 ng/mL, P = 0.06). After adjusting for age, prostate-specific antigen, digital rectal examination, and ethnic background, the odds ratio for a HGPIN diagnosis among men in the highest relative to the lowest quartile of serum IGF-I level was 1.94 (95% confidence interval, 1.0-3.7; P = 0.04). The potential association between a high serum IGF-I level and the presence of HGPIN may represent an important clue to understanding the basis for the relationship between IGF-I physiology and prostate cancer risk. Larger studies will be required to confirm this relationship.

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