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High Levels of Circulating Insulin-Like Growth Factor-I Increase Prostate Cancer Risk: A Prospective Study in a Population-Based Nonscreened Cohort

From the Department of Surgery and Perioperative Sciences, Urology and Andrology, Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden; Hormones and Cancer Group, International Agency for Research on Cancer, Lyon, France; and Department of Clinical Chemistry, University Hospital of Helsinki, Finland

Address reprint requests to Pär Stattin, MD, Department of Surgery and Perioperative sciences, Urology and Andrology, Umeå University Hospital, 901 85 Umeå, Sweden; e-mail: par.stattin{at}urologi.umu.se

PURPOSE: Insulin-like growth factor-I (IGF-I) stimulates proliferation and inhibits apoptosis in prostate cancer cells, and IGF-I has been associated with increased prostate cancer risk in some, but not all, epidemiologic studies.

SUBJECTS AND METHODS: We extended our previous case-control study nested in the Northern Sweden Health and Disease Cohort, a population-based cohort from a region where little prostate specific antigen (PSA) screening is done. Levels of IGF-I and IGF binding protein-3 (IGFBP-3) were measured in prediagnostic blood samples from a total of 281 men who were subsequently diagnosed with prostate cancer after recruitment (median, 5 years after blood collection) and from 560 matched controls.

RESULTS: Logistic regression analyses showed increases in prostate cancer risk with increasing plasma peptide levels, up to an odds ratio (OR) for top versus bottom quartile of IGF-I of 1.67 (95% CI, 1.02 to 2.71; P _trend = .05), which was attenuated after adjustment for IGFBP-3 to an OR of 1.47 (95% CI, 0.81 to 2.64; P _trend = .32). For men younger than 59 years at recruitment, OR for top versus bottom quartile of IGF-I was 4.12 (95% CI, 1.01 to 16.70; P _trend = .002), which was significantly stronger than for men older than 59 years (P _interaction = .006). For men with advanced cancer, OR for top versus bottom quartile of IGF-I was 2.87 (95% CI, 1.01 to 8.12; P _trend = .10).

CONCLUSION: Our data add further support for IGF-I as an etiologic factor in prostate cancer and indicate that circulating IGF-I levels measured at a comparatively young age may be most strongly associated with prostate cancer risk.

Supported by the Swedish Cancer Society (grant 01 0614) and Lions Cancer Foundation, Umeå, Sweden.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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