Chemoprevention strategies in prostate cancer
- E David Crawford, MD
E David Crawford, MD
- Professor of Surgery, Urology and Radiation Oncology
- University of Colorado Denver School of Medicine
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Prostate cancer is the second most common cancer in men worldwide, with an estimated 1,600,000 cases and 366,000 deaths annually . In the United States there will be an estimated 161,000 cases and 26,700 deaths in 2017 .
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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- Long latency period
- Androgen dependency
- Clinical trials biomarkers
- 5-ALPHA REDUCTASE INHIBITORS
- Finasteride: Prostate Cancer Prevention Trial
- Guidelines and regulatory status
- OTHER AGENTS
- Vitamins and micronutrients
- - Vitamin E
- - Selenium
- - Vitamin D analogs
- - Retinoids
- Nonsteroidal anti-inflammatory compounds
- Dietary factors
- LIFESTYLE FACTORS
- SUMMARY AND RECOMMENDATIONS