Prostate cancer primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]

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Overview

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 5-AR inhibitors, and the more limited data with other approaches are presented here. Screening for prostate cancer, an alternative approach that focuses on early detection to decrease morbidity and mortality Effective measures for the primary prevention of prostate cancer include healthy diet and maintaining healthy weight.

Primary Prevention

• The 5-alpha reductase inhibitors (5-ARIs) finasteride and dutasteride improve lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH), by blocking the conversion of testosterone to the more potent androgen dihydrotestosterone.
• Two randomized trials have shown a reduced risk of prostate cancer in men receiving 5-ARIs, concerns were raised about a possible increased risk of high-grade prostate cancers.
• Swedish population-based cohort study of all men over the age of 40 who had at least one prostate-specific antigen (PSA) test in Stockholm County between 2007 and 2015, men who were prescribed a 5-ARI had a decreased risk for prostate cancer, and the effect was larger with longer duration of exposure.
• The reduction was limited to patients with prostate cancers with Gleason score 6 to 7; there was no impact on the risk of higher-grade disease (Gleason score 8 to 10). These data provide some reassurance that treatment with a 5-ARI for lower urinary tract symptoms is safe with regard to prostate cancer risk, but long-term follow-up data demonstrating improved survival are needed to determine the role of 5-ARIs as chemopreventive agents.

Effective measures for the primary prevention of prostate cancer include:

• Healthy diet

• Low-fat diet
• More fruits and vegetables

• Healthy weight
• Statins
• Metformin
• Vitamin E
• Selenium