Pharmacological Approaches to Reducing the Risk of Prostate Cancer

Roger S. Rittmaster, Neil E. Fleshner, Ian M. Thompson

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations


Context: It is now possible to reduce a man's risk of developing biopsy-detectable prostate cancer. This review addresses the evidence and issues surrounding prostate cancer risk reduction. Objective: The scientific basis, therapeutic approach, and risks and benefits of prostate cancer prevention are reviewed. Special attention is given to data on 5α-reductase inhibitors (5-ARIs). Evidence acquisition: Medline searches consisted of articles published since 2003 regarding prostate cancer chemoprevention, prevention, or risk reduction, as well as searches around specific topics within this review. Evidence synthesis: Current data support the use of finasteride for prostate cancer risk reduction in appropriately selected men. The initial concern that finasteride increased the incidence of high-grade prostate cancer has not been confirmed by subsequent analyses. The efficacy of dutasteride, a dual 5-ARI, for prostate cancer risk reduction is currently being evaluated in men with elevated prostate-specific antigen (PSA). Other medical approaches to prostate cancer risk reduction, including statins, cyclooxygenase-2 (COX-2) inhibitors, selective estrogen receptor modulators, and dietary supplements, await validation in controlled clinical trials. Conclusions: It is now possible to reduce an individual man's risk of developing biopsy-detectable prostate cancer. The greatest benefit arises from decreasing the amount of unnecessary treatment in men harboring low-risk cancers. Presently, there is no evidence that 5-ARIs or any other approach to prostate cancer risk reduction will reduce the risk of lethal prostate cancers. Finasteride, however, does enhance the utility of PSA for diagnosing high-grade cancers.

Original languageEnglish (US)
Pages (from-to)1064-1074
Number of pages11
JournalEuropean Urology
Issue number5
StatePublished - May 1 2009


  • Dutasteride
  • Finasteride
  • PCPT
  • Prevention
  • Prostate cancer
  • Risk reduction

ASJC Scopus subject areas

  • Urology


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