Update on chemoprevention for prostate cancer

Abstract

Interest in prostate cancer prevention and risk reduction continues among both patients and clinicians. Recent studies on primary and secondary prevention of prostate cancer will be addressed. 5-alpha reductase inhibitors remain the predominant therapy to reduce the future risk of a prostate cancer diagnosis. Reanalysis of the Prostate Cancer Prevention Trial (PCPT) suggests that high-grade cancer is not associated with finasteride therapy. We await the results of the Reduction by Dutasteride of Prostate Cancer Events (REDUCE). Efforts to use isolated vitamins and nutrients have proved less successful. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) and the Physician's Health Study II showed negative results for vitamin E, vitamin C, and selenium supplementation on decreasing prostate cancer risk. Dutasteride and finasteride are currently the only proven agents for prostate cancer risk reduction. As potential modifiable risk factors are identified through epidemiologic and other investigations, additional active interventions should become more evident. A critical issue is timing of exposure to the active agent. Current trials may have studied men with pre-existing prostate cancer, or had the intervention applied too late to prevent the genetic alterations that would cause cancer. Ideally the optimal risk reduction intervention would prevent the malignant transformation of prostate cells from occurring in the first place.