Chemoprevention of prostate cancer: agents and study designs

With the completion of the Prostate Cancer Prevention Trial and the ongoing performance of several additional large-scale prostate cancer prevention trials interest in this intervention has increased. We review promising agents for prostate cancer prevention, clinical trial designs and how these agents may be used clinically.

We reviewed current and completed randomized chemoprevention trials for prostate cancer as well as the most promising agents for which evidence suggests that a decreased prostate cancer risk may result from their use.

Evidence suggests that lycopene, decreased dietary fat, antioxidants such as alpha-tocopherol and selenium, nonsteroidal anti-inflammatory drugs and selective estrogen receptor modulators such as toremifene and 5alpha-reductase inhibitors may prove useful for decreasing the risk of prostate cancer in a man. Ongoing studies are examining these agents in the 3 general scenarios of 1) general population studies (finasteride, alpha-tocopherol and selenium), 2) increased prostate specific antigen with negative biopsy (dutasteride) and 3) prostatic intraepithelial neoplasia (toremifene and selenium).

There are many agents that may decrease the risk of prostate cancer. It requires careful study of the agents in specific populations to determine whether risk is reduced, the magnitude of the risk reduction and the spectrum of side effects associated with the agent. Physicians caring for men entering the range of age of prostate cancer risk must be aware of these preventive opportunities.