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Published on: September 18, 2013
Effect of TNF-α Inhibitor Therapy on Growth of the Prostate Gland
Ra'ad Al-Faouri1, Christina Sharkey1, Boris Gershman1
1Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Background:
Inflammation has been linked to the development of benign prostatic hyperplasia (BPH). SRD5A2 is a pivotal enzyme in the development and growth of the prostate gland and a critical target for BPH therapy. TNF-α regulates epigenetic changes in SRD5A2, leading to suppression of SRD5A2 gene and protein expression. It is unknown whether TNF-α inhibitor therapy affects prostate growth.
Objective:
To evaluate the effect of TNF-α inhibitor therapy on prostate growth via analysis of measurements on serial pelvic imaging scans.
Design, Setting, And Participants:
In this retrospective cohort study, we analyzed serial pelvic cross-sectional imaging (magnetic resonance imaging or computed tomography scans) for men aged ≥18 yr receiving TNF-α inhibitors. Our inclusion/exclusion criteria yielded a treatment cohort of 99 men. An age-matched cohort was constructed with the same inclusion/exclusion criteria but without TNF-α therapy (n = 99).
Outcome Measurements And Statistical Analysis:
Prostate growth on serial pelvic cross-sectional imaging was the primary outcome measure.
Results And Limitations:
There was no significant difference in total prostate volume (TPV) at baseline between the two groups. The TNF-α treatment group had a lower mean TPV on follow-up (26.21 ± 9.43 vs 32.71 ± 18.89 cm3; p = 0.002) and a lower median prostate growth rate (-0.01 vs 0.68 cm3/yr; p = 0.001). A multivariable linear regression model adjusted for age, race, initial TPV, and body mass index also revealed a significantly lower growth rate for men in the treatment group.
Conclusion:
TNF-α inhibitor use was negatively correlated with the prostate growth rate, suggesting that inflammatory mediators regulate prostate growth.
Patient Summary:
We examined prostate growth rates in men taking TNF-α inhibitors and found that these drugs have a shrinking effect on the prostate. We conclude that TNF-α inhibitors may impede prostate growth.
Insights
Tumor necrosis factor-alpha (TNF-α) inhibitor therapy was associated with reduced prostate growth in men. These findings suggest that TNF-α inhibitors may impede benign prostatic hyperplasia progression.
Area of Science:
- Urology
- Inflammation research
- Pharmacology
Background:
- Inflammation is implicated in benign prostatic hyperplasia (BPH) development.
- Tumor necrosis factor-alpha (TNF-α) influences SRD5A2 gene expression, a key factor in prostate growth.
- The impact of TNF-α inhibitor therapy on prostate growth remains unclear.
Purpose of the Study:
- To investigate the effect of TNF-α inhibitor therapy on prostate growth.
- To analyze serial pelvic imaging measurements to assess prostate volume changes.
Main Methods:
- Retrospective cohort study of 99 men receiving TNF-α inhibitors and 99 age-matched controls.
- Analysis of serial pelvic cross-sectional imaging (MRI or CT scans).
- Primary outcome: prostate growth rate measured by changes in total prostate volume (TPV).
Main Results:
- No significant difference in baseline TPV between groups.
- The TNF-α inhibitor group showed a lower mean follow-up TPV (26.21 vs 32.71 cm³).
- Significantly lower median prostate growth rate in the TNF-α treatment group (-0.01 vs 0.68 cm³/yr).
Conclusions:
- TNF-α inhibitor use is negatively correlated with prostate growth rate.
- Inflammatory mediators appear to play a role in regulating prostate growth.
- TNF-α inhibitors may impede prostate growth, offering a potential therapeutic avenue for BPH.
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