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Prostate cancer prevention: concepts and clinical recommendations

Abstract

Prevention is an important strategy for limiting prostate cancer morbidity and mortality. Two major types of prevention are primary (reduction of incident cases) and tertiary (inhibition of disease progression and recurrence). Pharmacological and dietary interventions have potential functions in both the primary and tertiary prevention of prostate cancer. Five-α reductase inhibitors (5-ARIs) reduce the incidence of prostate cancer in both general and higher-risk populations and are currently under study for tertiary prevention in active surveillance and biochemical recurrence patients. Selenium, vitamin E, and vitamin C do not prevent incident prostate cancer in the general population; however, other promising diet-based interventions are currently under study for tertiary prevention. We recommend consideration of 5-ARIs for prostate cancer prevention in (1) asymptomatic men with a PSA 3.0 ng ml–1 who are undergoing or anticipate undergoing PSA screening for early detection of prostate cancer and (2) asymptomatic men with PSA 2.5 and 10 ng ml–1 and an earlier prostate biopsy negative for cancer. Men should be informed of the potential risks of 5-ARI therapy. Currently, there is neither clinical evidence to support the use of 5-ARIs for tertiary prevention in active surveillance or biochemical recurrence populations, nor micronutrients for prostate cancer prevention of any type.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ . Cancer statistics, 2009. CA Cancer J Clin 2009; 59: 225–249.

    Article  PubMed  Google Scholar 

  2. Saigal CS, Litwin MS . The economic costs of early stage prostate cancer. Pharmacoeconomics 2002; 20: 869–878.

    Article  PubMed  Google Scholar 

  3. Schroeck FR, Krupski TL, Sun L, Albala DM, Price MM, Polascik TJ et al. Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy. Eur Urol 2008; 54: 785–793.

    Article  PubMed  Google Scholar 

  4. Frank SJ, Pisters LL, Davis J, Lee AK, Bassett R, Kuban DA . An assessment of quality of life following radical prostatectomy, high dose external beam radiation therapy and brachytherapy iodine implantation as monotherapies for localized prostate cancer. J Urol 2007; 177: 2151–2156; discussion 2156.

    Article  PubMed  Google Scholar 

  5. Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360: 1320–1328.

    Article  PubMed  Google Scholar 

  6. Nelson WG, De Marzo AM, Isaacs WB . Prostate cancer. N Engl J Med 2003; 349: 366–381.

    Article  CAS  PubMed  Google Scholar 

  7. Cuzick J, Otto F, Baron JA, Brown PH, Burn J, Greenwald P et al. Aspirin and non-steroidal anti-inflammatory drugs for cancer prevention: an international consensus statement. Lancet Oncol 2009; 10: 501–507.

    Article  CAS  PubMed  Google Scholar 

  8. Singer EA, Palapattu GS, van Wijngaarden E . Prostate-specific antigen levels in relation to consumption of nonsteroidal anti-inflammatory drugs and acetaminophen: results from the 2001–2002 National Health and Nutrition Examination Survey. Cancer 2008; 113: 2053–2057.

    Article  PubMed  Google Scholar 

  9. Murtola TJ, Visakorpi T, Lahtela J, Syvala H, Tammela T . Statins and prostate cancer prevention: where we are now, and future directions. Nat Clin Pract Urol 2008; 5: 376–387.

    Article  CAS  PubMed  Google Scholar 

  10. Thomas LN, Douglas RC, Lazier CB, Too CK, Rittmaster RS, Tindall DJ . Type 1 and type 2 5alpha-reductase expression in the development and progression of prostate cancer. Eur Urol 2008; 53: 244–252.

    Article  CAS  PubMed  Google Scholar 

  11. Rittmaster RS, Manning AP, Wright AS, Thomas LN, Whitefield S, Norman RW et al. Evidence for atrophy and apoptosis in the ventral prostate of rats given the 5 alpha-reductase inhibitor finasteride. Endocrinology 1995; 136: 741–748.

    Article  CAS  PubMed  Google Scholar 

  12. Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG et al. The influence of finasteride on the development of prostate cancer. N Engl J Med 2003; 349: 215–224.

    Article  CAS  PubMed  Google Scholar 

  13. Lucia MS, Epstein JI, Goodman PJ, Darke AK, Reuter VE, Civantos F et al. Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2007; 99: 1375–1383.

    Article  CAS  PubMed  Google Scholar 

  14. Moinpour CM, Darke AK, Donaldson GW, Thompson Jr IM, Langley C, Ankerst DP et al. Longitudinal analysis of sexual function reported by men in the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2007; 99: 1025–1035.

    Article  PubMed  Google Scholar 

  15. Kramer BS, Hagerty KL, Justman S, Somerfield MR, Albertsen PC, Blot WJ et al. Use of 5-alpha-reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol 2009; 27: 1502–1516.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lippman SM, Klein EA, Goodman PJ, Lucia MS, Thompson IM, Ford LG et al. Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA 2009; 301: 39–51.

    Article  CAS  PubMed  Google Scholar 

  17. Yamaguchi K, Uzzo RG, Pimkina J, Makhov P, Golovine K, Crispen P et al. Methylseleninic acid sensitizes prostate cancer cells to TRAIL-mediated apoptosis. Oncogene 2005; 24: 5868–5877.

    Article  CAS  PubMed  Google Scholar 

  18. Lee SO, Yeon Chun J, Nadiminty N, Trump DL, Ip C, Dong Y et al. Monomethylated selenium inhibits growth of LNCaP human prostate cancer xenograft accompanied by a decrease in the expression of androgen receptor and prostate-specific antigen (PSA). Prostate 2006; 66: 1070–1075.

    Article  CAS  PubMed  Google Scholar 

  19. Etminan M, FitzGerald JM, Gleave M, Chambers K . Intake of selenium in the prevention of prostate cancer: a systematic review and meta-analysis. Cancer Causes Control 2005; 16: 1125–1131.

    Article  PubMed  Google Scholar 

  20. Cheung E, Wadhera P, Dorff T, Pinski J . Diet and prostate cancer risk reduction. Expert Rev Anticancer Ther 2008; 8: 43–50.

    Article  PubMed  Google Scholar 

  21. Crispen PL, Uzzo RG, Golovine K, Makhov P, Pollack A, Horwitz EM et al. Vitamin E succinate inhibits NF-kappaB and prevents the development of a metastatic phenotype in prostate cancer cells: implications for chemoprevention. Prostate 2007; 67: 582–590.

    Article  CAS  PubMed  Google Scholar 

  22. Heinonen OP, Albanes D, Virtamo J, Taylor PR, Huttunen JK, Hartman AM et al. Prostate cancer and supplementation with alpha-tocopherol and beta-carotene: incidence and mortality in a controlled trial. J Natl Cancer Inst 1998; 90: 440–446.

    Article  CAS  PubMed  Google Scholar 

  23. Chan JM, Stampfer MJ, Ma J, Rimm EB, Willett WC, Giovannucci EL . Supplemental vitamin E intake and prostate cancer risk in a large cohort of men in the United States. Cancer Epidemiol Biomarkers Prev 1999; 8: 893–899.

    CAS  PubMed  Google Scholar 

  24. Kirsh VA, Hayes RB, Mayne ST, Chatterjee N, Subar AF, Dixon LB et al. Supplemental and dietary vitamin E, beta-carotene, and vitamin C intakes and prostate cancer risk. J Natl Cancer Inst 2006; 98: 245–254.

    Article  CAS  PubMed  Google Scholar 

  25. Wright ME, Weinstein SJ, Lawson KA, Albanes D, Subar AF, Dixon LB et al. Supplemental and dietary vitamin E intakes and risk of prostate cancer in a large prospective study. Cancer Epidemiol Biomarkers Prev 2007; 16: 1128–1135.

    Article  CAS  PubMed  Google Scholar 

  26. Gaziano JM, Glynn RJ, Christen WG, Kurth T, Belanger C, MacFadyen J et al. Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians' Health Study II randomized controlled trial. JAMA 2009; 301: 52–62.

    Article  CAS  PubMed  Google Scholar 

  27. Mirvish SS . Role of N-nitroso compounds (NOC) and N-nitrosation in etiology of gastric, esophageal, nasopharyngeal and bladder cancer and contribution to cancer of known exposures to NOC. Cancer Lett 1995; 93: 17–48.

    Article  CAS  PubMed  Google Scholar 

  28. Wu HC, Lu HF, Hung CF, Chung JG . Inhibition by vitamin C of DNA adduct formation and arylamine N-acetyltransferase activity in human bladder tumor cells. Urol Res 2000; 28: 235–240.

    Article  CAS  PubMed  Google Scholar 

  29. Klein EA . Chemoprevention strategies. Grand Rounds Urol 2009; 8 (Suppl 1): 2–5.

    Google Scholar 

  30. Andriole G, Bostwick D, Brawley O, Gomella L, Marberger M, Montorsi F et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med 2010; 362: 1192–1202.

    Article  CAS  PubMed  Google Scholar 

  31. Zhu YS, Sun GH . 5alpha-reductase Isozymes in the prostate. J Med Sci 2005; 25: 1–12.

    PubMed  PubMed Central  Google Scholar 

  32. Titus MYL, Kawinski E, Kozyreva O, Mohler JL . Biochemical and pharmacological evidence for a third isozyme of steroid 5α-reductase in prostate cancer. J Urol 2007; 177 (Suppl): 90–91.

  33. Iehle C, Radvanyi F, Gil Diez de Medina S, Ouafik LH, Gerard H, Chopin D et al. Differences in steroid 5alpha-reductase iso-enzymes expression between normal and pathological human prostate tissue. J Steroid Biochem Mol Biol 1999; 68: 189–195.

    Article  CAS  PubMed  Google Scholar 

  34. Thomas LN, Lazier CB, Gupta R, Norman RW, Troyer DA, O'Brien SP et al. Differential alterations in 5alpha-reductase type 1 and type 2 levels during development and progression of prostate cancer. Prostate 2005; 63: 231–239.

    Article  CAS  PubMed  Google Scholar 

  35. Luo J, Dunn TA, Ewing CM, Walsh PC, Isaacs WB . Decreased gene expression of steroid 5 alpha-reductase 2 in human prostate cancer: implications for finasteride therapy of prostate carcinoma. Prostate 2003; 57: 134–139.

    Article  CAS  PubMed  Google Scholar 

  36. Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S . Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab 2004; 89: 2179–2184.

    Article  CAS  PubMed  Google Scholar 

  37. Wurzel R, Ray P, Major-Walker K, Shannon J, Rittmaster R . The effect of dutasteride on intraprostatic dihydrotestosterone concentrations in men with benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2007; 10: 149–154.

    Article  CAS  PubMed  Google Scholar 

  38. McConnell JD, Wilson JD, George FW, Geller J, Pappas F, Stoner E . Finasteride, an inhibitor of 5 alpha-reductase, suppresses prostatic dihydrotestosterone in men with benign prostatic hyperplasia. J Clin Endocrinol Metab 1992; 74: 505–508.

    CAS  PubMed  Google Scholar 

  39. Span PN, Voller MC, Smals AG, Sweep FG, Schalken JA, Feneley MR et al. Selectivity of finasteride as an in vivo inhibitor of 5alpha-reductase isozyme enzymatic activity in the human prostate. J Urol 1999; 161: 332–337.

    Article  CAS  PubMed  Google Scholar 

  40. Bonkhoff H, Fixemer T, Hunsicker I, Remberger K . Estrogen receptor expression in prostate cancer and premalignant prostatic lesions. Am J Pathol 1999; 155: 641–647.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Weinstein MH, Epstein JI . Significance of high-grade prostatic intraepithelial neoplasia on needle biopsy. Hum Pathol 1993; 24: 624–629.

    Article  CAS  PubMed  Google Scholar 

  42. Gallo F, Chiono L, Gastaldi E, Venturino E, Giberti C . Prognostic significance of high-grade prostatic intraepithelial neoplasia (HGPIN): risk of prostatic cancer on repeat biopsies. Urology 2008; 72: 628–632.

    Article  PubMed  Google Scholar 

  43. Parsons JK, Partin AW . Clinical interpretation of prostate biopsy reports. Urology 2006; 67: 452–457.

    Article  PubMed  Google Scholar 

  44. Epstein JI, Herawi M . Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J Urol 2006; 175 (3 Pt 1): 820–834.

    Article  PubMed  Google Scholar 

  45. Dong F, Reuther AM, Magi-Galluzzi C, Zhou M, Kupelian PA, Klein EA . Pathologic stage migration has slowed in the late PSA era. Urology 2007; 70: 839–842.

    Article  PubMed  Google Scholar 

  46. Fleshner N, Gomella LG, Cookson MS, Finelli A, Evans A, Taneja SS et al. Delay in the progression of low-risk prostate cancer: rationale and design of the Reduction by Dutasteride of Clinical Progression Events in Expectant Management (REDEEM) trial. Contemp Clin Trials 2007; 28: 763–769.

    Article  CAS  PubMed  Google Scholar 

  47. Heidenreich A, Aus G, Bolla M, Joniau S, Matveev VB, Schmid HP et al. EAU guidelines on prostate cancer. Eur Urol 2008; 53: 68–80.

    Article  PubMed  Google Scholar 

  48. Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC . Natural history of progression after PSA elevation following radical prostatectomy. JAMA 1999; 281: 1591–1597.

    Article  CAS  PubMed  Google Scholar 

  49. Andriole G, Lieber M, Smith J, Soloway M, Schroeder F, Kadmon D et al. Treatment with finasteride following radical prostatectomy for prostate cancer. Urology 1995; 45: 491–497.

    Article  CAS  PubMed  Google Scholar 

  50. Schroder FH, Bangma CH, Wolff JM, Alcaraz A, Montorsi F, Mongiat-Artus P et al. Can dutasteride delay or prevent the progression of prostate cancer in patients with biochemical failure after radical therapy? Rationale and design of the Avodart after Radical Therapy for Prostate Cancer Study. BJU Int 2009; 103: 590–596.

    Article  PubMed  Google Scholar 

  51. Sartor O, Gomella LG, Gagnier P, Melich K, Dann R . Dutasteride and bicalutamide in patients with hormone-refractory prostate cancer: the Therapy Assessed by Rising PSA (TARP) study rationale and design. Can J Urol 2009; 16: 4806–4812.

    PubMed  Google Scholar 

  52. Silberstein J, Parsons JK . Current concepts in diet and prostate cancer. Aging Health 2008; 4: 495–505.

    Article  CAS  Google Scholar 

  53. Cohen JH, Kristal AR, Stanford JL . Fruit and vegetable intakes and prostate cancer risk. J Natl Cancer Inst 2000; 92: 61–68.

    Article  CAS  PubMed  Google Scholar 

  54. Parsons JK, Newman V, Mohler JL, Pierce JP, Paskett E, Marshall J . The Men's Eating and Living (MEAL) study: a Cancer and Leukemia Group B pilot trial of dietary intervention for the treatment of prostate cancer. Urology 2008; 72: 633–637.

    Article  PubMed  Google Scholar 

  55. Parsons JK, Newman VA, Mohler JL, Pierce JP, Flatt S, Marshall J . Dietary modification in patients with prostate cancer on active surveillance: a randomized, multicentre feasibility study. BJU Int 2008; 101: 1227–1231.

    Article  PubMed  Google Scholar 

  56. Svatek RS, Lee JJ, Roehrborn CG, Lippman SM, Lotan Y . The cost of prostate cancer chemoprevention: a decision analysis model. Cancer Epidemiol Biomarkers Prev 2006; 15: 1485–1489.

    Article  PubMed  Google Scholar 

  57. Zeliadt SB, Etzioni RD, Penson DF, Thompson IM, Ramsey SD . Lifetime implications and cost-effectiveness of using finasteride to prevent prostate cancer. Am J Med 2005; 118: 850–857.

    Article  CAS  PubMed  Google Scholar 

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Silberstein, J., Parsons, J. Prostate cancer prevention: concepts and clinical recommendations. Prostate Cancer Prostatic Dis 13, 300–306 (2010). https://doi.org/10.1038/pcan.2010.18

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