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Chemoprevention strategies in prostate cancer

E David Crawford, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


Prostate cancer is the second most common cancer in men worldwide, with an estimated 1,100,000 cases and 307,000 deaths in 2012 [1]. In the United States there will be an estimated 181,000 cases and 26,100 deaths in 2016 [2].

In the United States, the incidence of prostate cancer detection dramatically rose in the early 1990s in conjunction with the increasing utilization of prostate-specific antigen (PSA) screening. After an initial peak, incidence rates fell, but they have persisted at a rate nearly twice that recorded in the pre-PSA era, suggesting that many cases are clinically indolent and would never have become clinically apparent. Despite the increase in diagnosis of early stage prostate cancer, the impact of earlier treatment on survival remains to be proven.

The implementation of the United States Preventative Services Task Force (USPSTF) guidelines assigning a recommendation level of D has reduced the number of men seeking early detection, as well as reduced the number of transrectal ultrasound (TRUS) biopsies. Some centers have reported an increase in men with more aggressive and advanced disease. (See "Screening for prostate cancer", section on 'Overdiagnosis'.)

The high incidence of prostate cancer, its associated morbidity and mortality, the complications associated with its treatment, and a partial understanding of its biologic basis have led to a focus on chemoprevention strategies. The most extensive data come from the use of 5-alpha reductase (5-AR) inhibitors; other classes of agents are also being explored.

The rationale for chemoprevention, the results with the 5-AR inhibitors, and data with other approaches are presented here. Screening for prostate cancer, an alternative approach that focuses on early detection to decrease morbidity and mortality, is discussed elsewhere. (See "Screening for prostate cancer".)


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Literature review current through: Sep 2016. | This topic last updated: May 16, 2016.
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