Serum inhibin, activin and follistatin in postmenopausal women with epithelial ovarian carcinoma

Objective To investigate the role of serum inhibin A, inhibin pro-alpha C i mmunoreactivity, activin A, and follistatin in postmenopausal women with ep ithelial ovarian cancer. Design Case-control study. Sample Serum samples from 27 postmenopausal women with epithelial ovarian c ancer and 54 controls from the general population participating in an ovari an cancer screening trial. Results Women with epithelial ovarian cancer had significantly higher serum levels of pro-alpha C immunoreactivity (P = 0.03), activin A (P = 0.004) a nd follistatin (P = 0.04), but not inhibin A (P = 0.13). Using the 90th cen tile in the control group as the cut off, pro-alpha C levels were elevated in 41% of women with epithelial ovarian cancer, while inhibin A was elevate d in only 15%. Using the 95th centile as the cut off, serum pro-alpha C was elevated in only 11% of women with epithelial ovarian cancer (3/27), while activin A was elevated in 48% (11/23). Follicle stimulating hormone levels were significantly lower in women with epithelial ovarian cancer (P = 0.01 ). Although, inhibin-related peptides can modulate follicle stimulating hor mone levels, there was no correlation between inhibin A, pro-alpha C immuno reactivity, activin A or follistatin and follicle stimulating hormone. Conclusion These data demonstrate that though there is preferential secreti on of precursor forms of the alpha subunit rather than dimeric inhibin A by epithelial ovarian cancer, pro-alpha C is unlikely to be a useful tumour m arker. Activin A is more commonly elevated in postmenopausal women with epi thelial ovarian cancer and its role asa tumour marker in the diagnosis and screening of epithelial ovarian cancer warrants further evaluation.