| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 3926771 | European Urology Supplements | 2009 | 5 Pages |
ContextAnalysis of the Prostate Cancer Prevention Trial (PCPT) demonstrates that there is no longer a prostate-specific antigen (PSA) threshold below which prostate cancer cannot be found. Treatment with finasteride reduces the number of positive biopsies for prostate cancer, but its effect on tumour grading remains highly debatable, and there is some uncertainty regarding the value of routine use of finasteride as a chemoprevention therapy against prostate cancer and in men with symptomatic benign prostatic hyperplasia (BPH). This group is not the best target for chemoprevention due to the risk of overprevention and exposure to potential side-effects.ObjectiveAn ideal target for chemoprevention may, therefore, be patients with high-grade prostatic intraepithelial neoplasia (HG-PIN). The aim of this review is to determine the ideal target population for chemoprevention studies in premalignant and malignant prostate adenocarcinoma and to investigate available preventive therapies. A renewed interest in active surveillance in patients with localised prostate cancer has also highlighted the value of preventing the evolution/progression of an already-diagnosed tumour through either diet or medication.Evidence acquisitionSeveral randomised and nonrandomised clinical trials published in the academic literature that study various available chemoprevention strategies in men with prostatic intraepithelial neoplasia (PIN) and prostate cancer have been reviewed for this paper.Evidence synthesisA number of potential preventive agents have been investigated in patients with HG-PIN, including hormones (flutamide, finasteride, leuprolide acetate) and antioxidants such as lycopene, selenium, and catechins. One of the most promising chemoprevention drugs is the selective oestrogen receptor modulator toremifene citrate.ConclusionsA better target for chemoprevention may be men with HG-PIN who have a high risk of developing prostate cancer in later life. It may be worth monitoring young men with a high risk of developing HG-PIN in the future as potential targets for chemoprevention rather than focusing only on chemoprevention in the high-risk HG-PIN patient group.
