Endocrinology of Benign and Malignant Prostate Disease in Aging

Summary: Prostate cancers are out to get us, and too many hypothesis on why they grow.

Interestingness: 3

Paper by Marco Marcelli, TC Shao and Glenn R Cunningham in the Journal of Anti-Aging Medicine, Volume 3, Issue 2, June 2000.

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This paper is about the relationship between androgens, testosterone (T) and dihydrotestosterone(DHT), and estrogens, and prostate cancer (CaP in the text for some reason, but I'll go with the more obvious PC) and benign prostate hyperplasia (BPH), but the bits that interested me were the general stats and information about PC and BPH. It is also one of those that is a summary itself so there's too much information and I end up paying attention to none of it.

Check these numbers out, mostly related to USA population, male only:

• 28.7% of new, nonskin cancers
• 12.7% of cancer-related deaths
• BPH in 10% of 35 year olds, >80% of 80 year olds.

Latent PCs found in

• 15-20% of 40-50 year olds (found in autopsies, deaths from other reasons)
• >50% of 60-70 year olds.

The latent PC numbers seem especially scary for me. They seem to indicate that if we do extend lifespan, these will become active problems, not just latent.

The study focuses quite a bit on cross-ethnic variation of PC and BPH rates, and correlations or lack thereof with androgen levels. It then runs through the non-exclusive hypothesis for the cause/s of BPH and PC. For BPH: increased androgen concentration, something about estrogen, dysregulation of growth factors, and an increased in the number of stem cells. For PC: mutation in SRD4A2, androgen receptor (AR) gene codon repeats, and insulin-like growth factor 1 (IGF-1). I didn't pay much attention to the details of the hyopthesis.

Treatment/preventions: 5alpha-reductase inhibitors (5alpha-reductase converts T to DHT), like finasteride, which supposedly work well in the prevention of BPH, but don't do much once BPH is severe (well, 20-30% reduction in volume). For PC, castration, I assume chemical, induces remission on 80% of PC patients, but it mostly lasts 12-18 months, after which the PC recovers and 70% of the patients die.

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