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Serum prolactin levels in men during retropubic prostatectomy
PRELIMINARY
COMMUNICATIONS
SERC’M PHOI,A(:‘I IN LEVELS RETROPUBIC
hl.
HOS,
.ll.I>. h1.D.
M. BEN-DAVID Z. PALTI,
PROSTATECTOMY
3l.D.
,4. SHAPIRO, M. CAINE,
IN MEN DURING
. PH . D
hJI. D.
From the Department of Obstetrics and Gynecology, Hadassah University Hospital, Mount Scopus, and the Departments of Urology and Pharmacology, Hadassah University Hospital, Ein Karem, Jerusalem
ABSTRACT Thirty-one patients who underwent retropubic prostatectomy under epidural anesthesia for benign hypertrophy of the prostate were checked for serum prolactin levels before and during operation. A significant increase in serum pro&tin levels was noted during operation after the removal of the prostate, as compared with levels just prior to its removal. This difference suggests high concentration of prolactin in the prostatic tissue, part of which was released into the bloodstream during the traumatic squeezing of the prostate.
There is no evidence of hormonal changes during the fifth and sixth decades of life which may cause the development of benign hypertrophy growth and of the prostate (BHP). ‘;* However, regression of the prostate is known to be affected by sex hormones including: testosand, perhaps, prolactin.4-6 terone, estrogens3 Prolactin may play a role in the growth of the prostate in laboratory animals.4-6 Specific receptors to prolactin have been found in prostate of the rat.’ It is possible that changes in prolactin concentration in the prostate, rather than serum levels, may play a role in the development of BHP. Material
and Methods
Thirty-one men who underwent retropubic prostatectomy for BHP under epidural anesthesia were checked for serum prolactin levels before and during operation. Blood samples were taken one hour prior to operation, during the operation just before opening the prostatic capsule, and immediately after the removal of
150
the prostate. The blood samples were centrifuged, and the serum was stored in -40” C. until prolactin was measured by radioimmunoassay. In all cases there was a significant elevation of serum prolactin levels during the operation before the removal of the prostate (paired t test x2 = 3.77 p < 0.01). There was another significant elevation immediately after the removal of the prostate as compared to baseline (paired t test x2 = 6.69 p < O.Ol), and to the levels just prior to the removal of the prostate (paired t test x2 = 2.6 p < 0.02). Table I shows the mean values of prolactin levels before the operation and during the
TABLE 1.
Mean values o_fserum prolactin levels -Prostate
Values
Basal
x
13.5 6.6
S.D.
UROLOGY /
(ng./ml.)Immediately Before Removal After Removal 22.4 13.6
29.9 15.9
FEBRUARY 1980 / VOLUME XV, NUMBER 2
P.O.
operation before and after the removal of the prostate. No correlation was found between the rise in serum prolactin levels and the weight of the prostate which was removed.
References 1. Kent JR, and Acone AB: Plasma testosterone levels and aging in males, in Vermeuler A, and Exley D: Symposium on Steroid Hormones. Androgenesis in Normal and Pathological Conditions, New York Excerpta Medica Foundation, 1966, p. 31. 2. Birkhoff JD, Lattimer JK, and Frantz AG: Role of prolactin in benign prostatic hypertrophy, Urology 4: 557 (1974). 3. Wende EF, Bmnnen GE, Putong PB, and Grayhack JT: The e5ect of orchiectomy and estrogens on benign prostatic hyperplasia, J. Ural. 108: 116 (1972). 4. Grayhack JR, and Lebowitz JM: E&xt of pmlactin on citric acid of lateral lobe of prostate of Sprague Dowley rat, Invest. Urol. 5: 87 (1967). 5. Thomas JA, et al: E&xts of prolactin and dihydrotestostemne upon the rat prostatic gland, Ural. Int. 31: 265 (1976). 6. Asano M, Kanzaki S, Sekiguch E, and Tasaka T: Inhibition of prostatic growth in rabbits with antibovine pmlactin serum, J. Ural. 106: 248 (1971). 7. Turkington RN: In Wolstenholme GEW, and Knight J, Eds: Ciba Foundation Symposium, Iactogenic Hormone, Edinburgh, E. S. Livingstone Ltd., 1972, p, III. 8. Ben-David M, and Chramback A: Preparation of bio- and immunoreactive human prolactin in milligram amounts from amniotic fluid in 60 per cent yield, Endocrinology 101: 250 (1977) 9. Aragona C, Bohnet HG, and Friesen HG: Localization of prolactin binding in prostate and testis: the role of serum pro&tin concentration on testicular LH receptors, Acta Endocrinol. 84: 402 (1977). 10. Barkey RJ, Sham J, Amit T, and Barzilai D: Specific binding of prolactin to seminal vesicle, prostate and testicular homogenates of immature, mature and aged rats, J. Endocrinol. 74: 163 (1977). 11. Helmerich D, and Altwein JE: Effect of prolactin and the antiprolactin Bromocriptin on the testosterone uptake and metabolism in androgen-sensitive and insensitive canine organs, Ural. Res. 4: 101 (1976). 12. Noel LG, Suh KH, Stone JG, and Frantz GA: Human prolactin and growth hormone release during surgery and other conditions of stress, J, Clin. Endocrinol. Metab. 35: 840 (1972).
Comment High concentration of prolactin in tissues may be the result of high concentration or saturation of its specific receptors. Specific prolactin receptors have been found in the prostates of laboratory animals;‘,g*10 its effect on growth of the prostate in these animals has been demonstrated;4-6 and the role of prolactin enhancing testosterone uptake by the prostate has been shown. ‘i Normal serum prolactin levels do not exclude the possibility that high prolactin concentration in the prostate may have an effect on the pathogenesis of BHP. Our results demonstrate the known effect of trauma, such as surgery, on elevation of serum during the few prolactin levels. i2 However, minutes needed to remove the prostate after opening its capsule, a second significant elevation of serum prolactin level appeared. It is suggested that this second elevation is caused by the release of prolactin from the prostatic tissue as a result of the aggressive squeezing of this organ during its removal. If, indeed, high prolactin concentration in prostatic tissue in cases of BHP can be found, as suggested in this report, it may be related to the pathogenesis of BHP in men.
UROLOGY
/
FEBRUARY
1980
/
VOLUME
XV, NUMBER
Box 24035
Jerusalem, Israel (DR. RON)
2
lijl
COMMUNICATIONS
SERC’M PHOI,A(:‘I IN LEVELS RETROPUBIC
hl.
HOS,
.ll.I>. h1.D.
M. BEN-DAVID Z. PALTI,
PROSTATECTOMY
3l.D.
,4. SHAPIRO, M. CAINE,
IN MEN DURING
. PH . D
hJI. D.
From the Department of Obstetrics and Gynecology, Hadassah University Hospital, Mount Scopus, and the Departments of Urology and Pharmacology, Hadassah University Hospital, Ein Karem, Jerusalem
ABSTRACT Thirty-one patients who underwent retropubic prostatectomy under epidural anesthesia for benign hypertrophy of the prostate were checked for serum prolactin levels before and during operation. A significant increase in serum pro&tin levels was noted during operation after the removal of the prostate, as compared with levels just prior to its removal. This difference suggests high concentration of prolactin in the prostatic tissue, part of which was released into the bloodstream during the traumatic squeezing of the prostate.
There is no evidence of hormonal changes during the fifth and sixth decades of life which may cause the development of benign hypertrophy growth and of the prostate (BHP). ‘;* However, regression of the prostate is known to be affected by sex hormones including: testosand, perhaps, prolactin.4-6 terone, estrogens3 Prolactin may play a role in the growth of the prostate in laboratory animals.4-6 Specific receptors to prolactin have been found in prostate of the rat.’ It is possible that changes in prolactin concentration in the prostate, rather than serum levels, may play a role in the development of BHP. Material
and Methods
Thirty-one men who underwent retropubic prostatectomy for BHP under epidural anesthesia were checked for serum prolactin levels before and during operation. Blood samples were taken one hour prior to operation, during the operation just before opening the prostatic capsule, and immediately after the removal of
150
the prostate. The blood samples were centrifuged, and the serum was stored in -40” C. until prolactin was measured by radioimmunoassay. In all cases there was a significant elevation of serum prolactin levels during the operation before the removal of the prostate (paired t test x2 = 3.77 p < 0.01). There was another significant elevation immediately after the removal of the prostate as compared to baseline (paired t test x2 = 6.69 p < O.Ol), and to the levels just prior to the removal of the prostate (paired t test x2 = 2.6 p < 0.02). Table I shows the mean values of prolactin levels before the operation and during the
TABLE 1.
Mean values o_fserum prolactin levels -Prostate
Values
Basal
x
13.5 6.6
S.D.
UROLOGY /
(ng./ml.)Immediately Before Removal After Removal 22.4 13.6
29.9 15.9
FEBRUARY 1980 / VOLUME XV, NUMBER 2
P.O.
operation before and after the removal of the prostate. No correlation was found between the rise in serum prolactin levels and the weight of the prostate which was removed.
References 1. Kent JR, and Acone AB: Plasma testosterone levels and aging in males, in Vermeuler A, and Exley D: Symposium on Steroid Hormones. Androgenesis in Normal and Pathological Conditions, New York Excerpta Medica Foundation, 1966, p. 31. 2. Birkhoff JD, Lattimer JK, and Frantz AG: Role of prolactin in benign prostatic hypertrophy, Urology 4: 557 (1974). 3. Wende EF, Bmnnen GE, Putong PB, and Grayhack JT: The e5ect of orchiectomy and estrogens on benign prostatic hyperplasia, J. Ural. 108: 116 (1972). 4. Grayhack JR, and Lebowitz JM: E&xt of pmlactin on citric acid of lateral lobe of prostate of Sprague Dowley rat, Invest. Urol. 5: 87 (1967). 5. Thomas JA, et al: E&xts of prolactin and dihydrotestostemne upon the rat prostatic gland, Ural. Int. 31: 265 (1976). 6. Asano M, Kanzaki S, Sekiguch E, and Tasaka T: Inhibition of prostatic growth in rabbits with antibovine pmlactin serum, J. Ural. 106: 248 (1971). 7. Turkington RN: In Wolstenholme GEW, and Knight J, Eds: Ciba Foundation Symposium, Iactogenic Hormone, Edinburgh, E. S. Livingstone Ltd., 1972, p, III. 8. Ben-David M, and Chramback A: Preparation of bio- and immunoreactive human prolactin in milligram amounts from amniotic fluid in 60 per cent yield, Endocrinology 101: 250 (1977) 9. Aragona C, Bohnet HG, and Friesen HG: Localization of prolactin binding in prostate and testis: the role of serum pro&tin concentration on testicular LH receptors, Acta Endocrinol. 84: 402 (1977). 10. Barkey RJ, Sham J, Amit T, and Barzilai D: Specific binding of prolactin to seminal vesicle, prostate and testicular homogenates of immature, mature and aged rats, J. Endocrinol. 74: 163 (1977). 11. Helmerich D, and Altwein JE: Effect of prolactin and the antiprolactin Bromocriptin on the testosterone uptake and metabolism in androgen-sensitive and insensitive canine organs, Ural. Res. 4: 101 (1976). 12. Noel LG, Suh KH, Stone JG, and Frantz GA: Human prolactin and growth hormone release during surgery and other conditions of stress, J, Clin. Endocrinol. Metab. 35: 840 (1972).
Comment High concentration of prolactin in tissues may be the result of high concentration or saturation of its specific receptors. Specific prolactin receptors have been found in the prostates of laboratory animals;‘,g*10 its effect on growth of the prostate in these animals has been demonstrated;4-6 and the role of prolactin enhancing testosterone uptake by the prostate has been shown. ‘i Normal serum prolactin levels do not exclude the possibility that high prolactin concentration in the prostate may have an effect on the pathogenesis of BHP. Our results demonstrate the known effect of trauma, such as surgery, on elevation of serum during the few prolactin levels. i2 However, minutes needed to remove the prostate after opening its capsule, a second significant elevation of serum prolactin level appeared. It is suggested that this second elevation is caused by the release of prolactin from the prostatic tissue as a result of the aggressive squeezing of this organ during its removal. If, indeed, high prolactin concentration in prostatic tissue in cases of BHP can be found, as suggested in this report, it may be related to the pathogenesis of BHP in men.
UROLOGY
/
FEBRUARY
1980
/
VOLUME
XV, NUMBER
Box 24035
Jerusalem, Israel (DR. RON)
2
lijl