Chemoprevention of prostate cancer: an updated view
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To place chemoprevention of prostate cancer in current clinical context.
Review of recently published updates of large, randomized, controlled trials of primary chemoprevention of prostate cancer.
With extended post-intervention follow-up, SELECT demonstrated a 17% increased risk of prostate cancer relative to placebo in the vitamin E alone arm. Two other trials in men with high-grade PIN demonstrated no effect of selenium alone or in combination with soy and lycopene. Trials of 5α-reductase inhibitors show an approximate 25% relative risk reduction in men at average risk and in those with an “elevated” PSA and prior negative biopsy, but adoption of these agents in clinical practice has been limited by concerns over an apparently increased risk of high-grade disease.
Primary prevention of prostate cancer remains an attractive goal because of its prevalence and treatment-related morbidity. Neither selenium nor vitamin E prevents prostate cancer. The benefit/risk ratio for 5α-reductase inhibitors can be improved by limiting their use to men at high risk.
KeywordsSelenium Vitamin E 5α-Reductase inhibitors Prostate cancer Chemoprevention
Conflict of interest
Dr. Thompson declares that he has no conflict of interest. Dr. Klein served as an unpaid advisor to Merck and as a paid consultant to GSK (honorarium received of $3,000) in their preparations for the FDA Advisory Committee meeting on December 10, 2010 regarding a label indication for finasteride and dutasteride for the prevention of prostate cancer.
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