Prostate cancer primary prevention

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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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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 5α-reductase inhibitors such as 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[1].
  • 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:

  • Low-fat diet
  • More fruits and vegetables


  1. Wallerstedt A, Strom P, Gronberg H, Nordstrom T, Eklund M (November 2018). "Risk of Prostate Cancer in Men Treated With 5α-Reductase Inhibitors-A Large Population-Based Prospective Study". J. Natl. Cancer Inst. 110 (11): 1216–1221. doi:10.1093/jnci/djy036. PMID 29548030.
  2. Cuzick J, Thorat MA, Andriole G, Brawley OW, Brown PH, Culig Z, Eeles RA, Ford LG, Hamdy FC, Holmberg L, Ilic D, Key TJ, La Vecchia C, Lilja H, Marberger M, Meyskens FL, Minasian LM, Parker C, Parnes HL, Perner S, Rittenhouse H, Schalken J, Schmid HP, Schmitz-Dräger BJ, Schröder FH, Stenzl A, Tombal B, Wilt TJ, Wolk A (October 2014). "Prevention and early detection of prostate cancer". Lancet Oncol. 15 (11): e484–92. doi:10.1016/S1470-2045(14)70211-6. PMC 4203149. PMID 25281467.
  3. Platz EA, Leitzmann MF, Visvanathan K, Rimm EB, Stampfer MJ, Willett WC, Giovannucci E (December 2006). "Statin drugs and risk of advanced prostate cancer". J. Natl. Cancer Inst. 98 (24): 1819–25. doi:10.1093/jnci/djj499. PMID 17179483.
  4. Margel D, Urbach DR, Lipscombe LL, Bell CM, Kulkarni G, Austin PC, Fleshner N (September 2013). "Metformin use and all-cause and prostate cancer-specific mortality among men with diabetes". J. Clin. Oncol. 31 (25): 3069–75. doi:10.1200/JCO.2012.46.7043. PMID 23918942.
  5. "The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers". N. Engl. J. Med. 330 (15): 1029–35. April 1994. doi:10.1056/NEJM199404143301501. PMID 8127329.
  6. Fleshner NE, Kapusta L, Donnelly B, Tanguay S, Chin J, Hersey K, Farley A, Jansz K, Siemens DR, Trpkov K, Lacombe L, Gleave M, Tu D, Parulekar WR (June 2011). "Progression from high-grade prostatic intraepithelial neoplasia to cancer: a randomized trial of combination vitamin-E, soy, and selenium". J. Clin. Oncol. 29 (17): 2386–90. doi:10.1200/JCO.2010.32.0994. PMID 21537051.

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