High levels of circulating insulin-like growth factor-I increase prostate cancer risk: A prospective study in a population-based nonscreened cohort

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 lGF-I of 1.67 (95% Cl, 1.02 to 2.71; P-trend = .05), which was attenuated after adjustment for IGFBP-3 to an OR of 1.47 (95% Cl, 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% Cl, 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% Cl, 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. (C) 2004 by American Society of Clinical Oncology.