TY - JOUR
T1 - Pharmacological Approaches to Reducing the Risk of Prostate Cancer
AU - Rittmaster, Roger S.
AU - Fleshner, Neil E.
AU - Thompson, Ian M.
PY - 2009/5/1
Y1 - 2009/5/1
N2 - 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.
AB - 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.
KW - Dutasteride
KW - Finasteride
KW - PCPT
KW - Prevention
KW - Prostate cancer
KW - REDUCE
KW - Risk reduction
UR - http://www.scopus.com/inward/record.url?scp=62649144537&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=62649144537&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2009.01.037
DO - 10.1016/j.eururo.2009.01.037
M3 - Review article
C2 - 19200641
AN - SCOPUS:62649144537
VL - 55
SP - 1064
EP - 1074
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 5
ER -