Insulin-like growth factors (IGFs) are potent mitogens that stimulate the growth of prostate cells. In serum, IGFs circulate bound to IGF-binding proteins (IGFBPs), which modulate their proliferative action. We studied the electrophoretic pattern of IGFBPs in the serum of patients with prostate cancer and in individuals with increased serum levels of prostate-specific antigen (PSA) in the absence of prostate malignancy. Serum IGFBP-2 was dramatically increased in patients with metastatic prostate cancer compared with healthy controls (23.83 +/- 6.93% vs. 2.95 +/- 0.52% of total serum IGFBPs; P < 0.02). A moderate rise in IGFBP-2 was also observed among patients with increased PSA without malignancy. In contrast, a decrease in serum IGFBP-3 was detected in most patients with metastatic prostate cancer (68.2 +/- 9.1% vs. 95.4 +/- 0.9% of total serum IGFBPs; P < 0.02) and was more pronounced in advanced cases. A highly significant correlation between serum IGFBP-2 and PSA levels was found (r = 0.62; P < 0.002), with a significant negative correlation between serum PSA and IGFBP-3 (r = -0.63; P < 0.002). We suggest that IGFBPs may be involved in growth modulation of prostate malignancy and that alterations in their serum levels may serve as a marker for prostate cancer.

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A review of our records between 1970 and 1986 identified 22 patients with transitional cell carcinoma of the bladder who were less than 31 years old. Of these patients 7 were less than 20 years old (group 1) and 15 were 20 to 30 years old (group 2). The tumors usually were of low grade and low stage. Patients in group 1 had no recurrences, whereas 6 patients (40 per cent) in group 2 had recurrences. Upstaging occurred in 2 patients with tumor recurrence. It would appear that while transitional cell carcinoma of the bladder in patients less than 20 years old has a more favorable prognosis, in patients 20 to 30 years old the prognosis is poorer and similar to that observed in older patients.