Elevated insulin and reduced insulin like growth factor binding protein-3/prostate specific antigen ratio with increase in prostate size in Benign Prostatic Hyperplasia

Clin Chim Acta. 2017 Jun;469:37-41. doi: 10.1016/j.cca.2017.03.012. Epub 2017 Mar 11.


Background: Insulin and insulin like growth factor-1 (IGF-1) have growth promoting effects, while insulin like growth factor binding protein-3 (IGFBP-3) has growth inhibitory effects. The present study was designed to assess the concentrations of insulin, IGF-1, IGFBP-3 and their association with prostate size in patients with BPH.

Methods: Ninety 90 BPH cases and 90 controls were enrolled in the study. Insulin, IGF-1, IGFBP-3, PSA, testosterone and estradiol were estimated in both the groups.

Results: Insulin, IGF-1 and estradiol were increased and IGFBP-3/PSA was decreased in BPH cases when compared with controls. Insulin (r=0.64, p=0.001) and IGF-1 (r=0.22, p=0.03) were positively correlated and IGFBP-3/PSA (r=-0.316, p=0.002) were negatively correlated with prostate size in BPH. Multivariate analysis showed that insulin (p=0.001) and IGFBP-3/PSA (p=0.004) predicts the prostate size in patients with BPH. Insulin was increased and IGFBP-3/PSA was reduced in BPH patients with increased prostate size. At a cutoff concentration of 527.52, IGFBP-3/PSA ratio was found to differentiate benign growth of prostate from normal prostate with 96% sensitivity and 96% specificity.

Conclusion: Insulin is elevated and IGFBP-3/PSA is reduced with increase prostate size in BPH cases.

Keywords: Benign Prostatic Hyperplasia; Estradiol; Insulin; Insulin like growth factor; Insulin like growth factor binding protein; Prostate specific antigen; Testosterone.

MeSH terms

  • Humans
  • Insulin / blood*
  • Insulin-Like Growth Factor Binding Protein 3 / blood*
  • Insulin-Like Growth Factor I / metabolism
  • Male
  • Middle Aged
  • Organ Size
  • Prostate / pathology*
  • Prostate-Specific Antigen / blood*
  • Prostatic Hyperplasia / blood*
  • Prostatic Hyperplasia / pathology*


  • IGFBP3 protein, human
  • Insulin
  • Insulin-Like Growth Factor Binding Protein 3
  • Insulin-Like Growth Factor I
  • Prostate-Specific Antigen