Review of the role of androgenic hormones in the epidemiology of benign prostatc hyperplasia and prostate cancer

Objective. Examine current knowledge and concepts on the role of androgenic hormones in the epidemiology of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). Methods. Review of the clinical and scientific literature on normal androgen physiology, hormonal physiology of BPH and PCa tissue, serum hormone levels in patients with BPH or PCa, and the correlation between serum and tissue androgenic hormones. Results. BPH and PCa are enormous clinical problems for our health care system; profound changes in the clinical aspects of these diseases are evident in recent years. Early identification or prevention are realistic goals; identification of higher risk groups would be extremely valuable. Androgen stimulation of the prostate is likely to be important in the promotion of BPH or PCa. Tissue hormone measurements have not identified substantial differences in hormone levels, but precise pathologic control of the tissue examined is suspect. Examinations of serum hormone levels in disease states have produced conflicting results, but the presence or absence of BPH or PCa was often based on imprecise clinical observations, making interpretation difficult. There are minimal data confirming that the serum hormones measured previously actually reflect intraprostatic tissue activity. Conclusions. The value of serum hormone measurements to identify higher risk groups for BPH or PCa is an area of continuing uncertainty because of substantial flaws in the design of many previous studies based on a failure both to define the presence or absence of BPH or PCa precisely in patients studied and measure the appropriate androgen metabolites. Similarly, it is not possible reliably to implicate differences in androgenic stimulation as a cause for racial differences in PCa. The ability of serum hormone levels to correlate with prostatic tissue androgenic stimulation has not been evaluated. Additional research in the relationships between androgenic stimulation and the development of clinically significant BPH or PCa is needed.