Nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 selective inhibitors for prostate cancer chemoprevention

There is increasing evidence that using nonsteroidal anti-inflammatory drugs decreases the incidence of clinically apparent prostate cancer. We review the potential mechanisms of cancer reduction with cyclooxygenase (COX)-2 inhibitors and the clinical evidence suggesting their effectiveness. A literature review using MEDLINE was conducted of animal, observational, and clinical studies of nonsteroidal anti-inflammatory drugs in cancer, specifically prostate cancer. The Physician Data Query database was searched for current studies of COX-2 inhibitors for chemoprevention of prostate cancer. Research suggests that COX-2 inhibiting medications are determinants in lower cancer incidence rates. Other studies have suggested up-regulation of the COX-2 enzyme in prostate cancer compared with normal prostate tissue. Selective COX-2 inhibitors are currently under study to evaluate their potential roles in preventing prostate cancer in high-risk patients (rofecoxib) or the recurrence of bladder cancer (celecoxib). Agents such as exisulind, which is a selective apoptotic antineoplastic drug, are also under investigation. COX-2 inhibitors are promising agents for the chemoprevention of prostate cancer but further research is needed.