Chemoprevention of Prostate Cancer: Myths and Realities

BACKGROUND: Prostate cancer will affect 15% to 18% of men in North America and will result in death in 3%. Established curative and palliative treatments for prostate cancer are associated with significant morbidity and cost. For these reasons, prostate cancer is an ideal target for prevention. METHODS: Using MEDLINE we performed a systematic review of clinical trials that have investigated pharmaceutical or nutritional interventions for the prevention of prostate cancer. The available evidence was critically evaluated and summarized according to the strength of recommendation taxonomy. RESULTS: Many pharmaceutical and nutritional interventions have been investigated for the prevention of prostate cancer. The strongest evidence exists to support the use of 5 α-reductase inhibitors (5-ARIs) for prevention of prostate cancer. However, the evidence is insufficient to recommend that these agents be used routinely among all men. In addition, the optimal timing or duration of 5-ARI use in not known. At present there is no suitable evidence to recommend using any specific nutritional supplement or diet to prevent prostate cancer. CONCLUSIONS: Prostate cancer prevention should not be offered systematically to all men. There may be a role for 5-ARI use among motivated men who wish to take a proactive approach to prostate cancer prevention.