Prevention Strategies in Prostate Cancer

N E Fleshner,N Lawrentschuk,Greg Trottier

doi:10.3747/co.v17i0.703

Abstract

Prostate cancer (PCa) prevention has been an exciting and controversial topic since the results of the Prostate Cancer Prevention Trial (PCPT) were published. With the recently published results of the reduce (Reduction by Dutasteride of Prostate Cancer Events) trial, interest in this topic is at a peak. Primary pca prevention will be unlikely to affect mortality significantly, but the reduction in overtreatment and the effect on quality of life from the avoidance of a cancer diagnosis are important factors to consider.This review provides a comparative update on the REDUCE and PCPT trials and some clinical recommendations. Other potential primary preventive strategies with statins, selective estrogen response modulators, and nutraceutical compounds-including current evidence for these agents and their roles in clinical practice-are discussed. Many substances that have been examined in the primary prevention of pca and for which clinical data are either negative or particularly weak are not covered.The future of PCa prevention continues to expand, with several ongoing clinical trials and much interest in tertiary prostate cancer prevention.

Highlights

Prostate cancer is the most common cancer in men, and there is much debate about treatment approaches and screening for the disease
This review presents the evidence for successful and potential primary prevention strategies associated with modifiable risk factors for pca and includes some guidance on how those strategies can be incorporated into clinical practice
With the results of the reduce trial resolving some of the controversy over the increased risk of high-grade disease, the questions are these: Who outside of the symptomatic benign prostatic hyperplasia population should be considered, and when should they start these medications?

Summary

INTRODUCTION

Prostate cancer (pca) is the most common cancer in men, and there is much debate about treatment approaches and screening for the disease. ● Prevention could result in cost savings by reducing the number of men needing radical treatment. ● A reduction in the number of patients with clinically insignificant cancer followed on active surveillance protocols could reduce costs and the psychological impact of living with cancer. Proposed modifiable risk factors for pca that are potential targets for prevention include prostate inflammation, the endocrine–sex steroid axis, dietary factors, and obesity. Sex steroids are important in the pathogenesis of pca, with strong evidence for targeting this axis in primary prevention. This review presents the evidence for successful and potential primary prevention strategies associated with modifiable risk factors for pca and includes some guidance on how those strategies can be incorporated into clinical practice

Chemoprevention with 5α-Reductase Inhibitors

Findings

Chemoprevention with Other Agents

SUMMARY