Prostatic Enlargement in Acromegaly Despite Preserved Lower Urinary Tract Function: A Cross‐Sectional Comparative Study

BACKGROUND: Acromegaly is characterized by organomegaly driven by chronic GH/IGF-1 excess, and the prostate gland may be affected as part of this generalized organ enlargement. Although prostatic enlargement has been documented in previous studies, whether it is accompanied by symptomatic or functional impairment and its potential impact on quality of life remain unclear. This study aimed to evaluate prostate-related changes in male patients with active and remitting acromegaly compared to healthy controls, and to assess their association with lower urinary tract symptoms, mood, and quality of life. METHODS: This cross-sectional study included 57 male patients with acromegaly (25 active, 32 in remission) and 24 healthy male controls of comparable age and BMI. All participants underwent transabdominal prostate ultrasonography, uroflowmetry, and completed the IPSS, SF-36, PHQ-9, GAD-7, and FSS questionnaires. The AcroQoL was administered to the acromegaly group. Correlations between IGF-1 levels and prostate parameters were analyzed using Spearman's correlation. RESULTS: Patients with acromegaly had a larger median prostate volume (30 vs. 20 mL, p = 0.03), more frequently had a prostate volume exceeding 30 mL (47% vs. 11%, p = 0.004), and more frequently had prostatic calcification (31% vs. 5%, p = 0.03) than controls, despite lower testosterone levels. Within the acromegaly group, a prostate volume exceeding 30 mL was more frequent in active disease than in remission (64% vs. 33%, p = 0.02), whereas median prostate volume did not differ significantly (31 vs. 24.5 mL, p = 0.1). IGF-1 was correlated with free PSA (rho = 0.29, p = 0.03) but not with total prostate volume (rho = 0.09, p = 0.53). Calcification rates did not differ by remission status. No significant differences were observed in IPSS scores, uroflowmetry parameters, SF-36, PHQ-9, GAD-7, or AcroQoL between groups. CONCLUSION: Male patients with acromegaly have larger prostate volumes and more frequent prostatic calcification than controls; prostatic enlargement was more frequent in active disease, whereas calcification did not differ by remission status. These structural alterations were not accompanied by differences in lower urinary tract symptoms, uroflowmetry parameters, or quality of life, suggesting that dedicated urologic surveillance may not be warranted in asymptomatic middle-aged patients.