Impact of radical prostatectomy and TURP on the hypothalamic-pituitary-gonadal hormone axis.
OBJECTIVE
To assess the impact of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) on the hypothalamic-pituitary hormone axis, we determined the endocrine changes after radical prostatectomy (RP) and transurethral resection of the prostate (TURP) for BPH and in a group of men with BPH followed up conservatively.


METHODS
Patients with PCa before RP (n = 49), those who underwent TURP for BPH (n = 51), and men with lower urinary tract symptoms for whom a wait-and-see strategy was chosen (n = 46) were included. Serum levels of total testosterone, luteinizing hormone, and follicle-stimulating hormone were determined at baseline and 6 and 12 months later in all patients.


RESULTS
No significant endocrine changes were observed in the wait-and-see and TURP groups 6 and 12 months after baseline. In contrast, luteinizing hormone increased from 5.2 to 8.9 mIU/mL (P = 0.0004) and follicle-stimulating hormone from 5.7 to 9.3 mIU/mL (P = 0.0003) 12 months after RP. The rise of total testosterone from 3.9 to 4.4 ng/mL failed to reach statistical significance (P = 0.18). Patients with Gleason score 2 to 6 PCa had higher testosterone values (4.2 ng/mL) at baseline than did those with Gleason score 7 to 10 PCa (2.2 ng/mL, P < 0.05). Although 12 months after RP no changes in testosterone were observed in the low Gleason score group, the testosterone levels more than doubled in those with high-grade tumors. The increases in luteinizing hormone and follicle-stimulating hormone at 12 months, however, were comparable in both groups.


CONCLUSIONS
Our findings suggest a significant impact of PCa on the hypothalamic-pituitary axis that is more profound in high-grade cancer. Such an effect was not demonstrable for the transition zone in BPH.
Madersbacher
Stephan
S
Department of Urology, University of Vienna, Vienna, Austria.
Schatzl
Georg
G
Bieglmayer
Christian
C
Reiter
Werner J
WJ
Gassner
Christa
C
Berger
Peter
P
Zidek
Thomas
T
Marberger
Michael
M
D000368:Aged; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000097:blood / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D012016:Reference Values; D013739:Testosterone / Q000097:blood*
D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone