Plasma steroid hormones, surgery for benign prostatic hyperplasia, and severe lower urinary tract symptoms

Because benign prostatic hyperplasia (BPH) may be influenced by plasma ster oid hormones, we examined their relation in the Health Professionals Follow -up Study. In 1993-1995, 18,000 cohort members provided blood. We selected as cases men who had had surgery for BPH (n = 174) or who scored 20-35 poin ts (n = 126) on the American Urological Association index of severity of lo wer urinary tract symptoms. Cases were matched by age to men who scored les s than or equal to 3 points and without an enlarged prostate or elevated pr ostate-specific antigen. We estimated the odds ratio (OR) of BPH surgery an d severe lower urinary tract symptoms for plasma testosterone (T), dihydrot estosterone (DHT), androstanediol glucuronide (AAG), estradiol (E2), and se x hormone binding globulin (SHBG) in multivariable conditional logistic reg ression models. Compared to the lowest tertiles, men in the middle (OR=1.42) and top (OR=1. 78) tertiles of AAG were at increased risk for having either BPH surgery or severe lower urinary tract symptoms (P-trend=0.02). Men in the middle (OR= 0.58) and top (OR=0.60) tertiles of E2 were at lower risk. T level was unre lated to surgery and symptoms. Our findings support opposing roles for DHT, reflected by its metabolite AA G, and E2 in the etiology of BPH.