Dutasteride: novel milestones in prostate cancer chemoprevention

Prostate cancer (PCa) remains the most-diagnosed cancer and the second leading cause of cancer death among men in the Unites States with over 32,000 deaths estimated in 2010 alone (1). Since the beginning of the prostate-specific antigen era, the incidence of biopsy-detected PCa has increased significantly, resulting in a stage migration towards indolent, slow-growing cancers and ensuring that relatively few men present at advanced stages of disease (2). These issues highlight the need to not only consider the approach to secondary prevention (clinical screening) but also explore the potential of primary chemoprevention for this disease that affects 1 in 6 men over their lifetimes. Out of experiences with the landmark Prostate Cancer Prevention Trial (PCPT) and the REduction by DUtasteride of prostate Cancer Events (REDUCE) trial, we have learned of promising abilities to reduce the prevalence of PCa with a class of medications called 5α-reductase inhibitors (3, 4). This review will address the basis for chemoprevention, examine the role of serum and prostatic androgens in prostate growth and development of PCa, review unanswered questions from the PCPT, discuss results of the recently released REDUCE trial that looked at the ability of dutasteride to decrease the prevalence of PCa, and explore future clinical roles for these medications and chemoprevention in general.