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Effective Strategies for Prostate Cancer Prevention

Prostate cancer poses significant risks, especially in African-American men who face nearly double the incidence compared to Caucasian men. Family history intensifies diagnosis risks by 2-3 times. Strategies to mitigate risks include maintaining a healthy weight, utilizing 5-alpha reductase inhibitors like finasteride and dutasteride, and considering lifestyle factors such as vitamin D and statin use. Studies reveal mixed results for supplements like vitamin E and selenium. Awareness and education about individual risks and preventive measures are crucial for effective prostate cancer management.

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Effective Strategies for Prostate Cancer Prevention

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  1. Prevention Strategies Rajesh G. Laungani MD Director, Robotic Urology Chairman, Prostate Cancer Center Saint Joseph’s Hospital, Atlanta

  2. Who Is at Greatest Risk? • Prostate cancer is almost twice as common in African-American men than in Caucasian men • African Americans are more than twice as likely to die when diagnosed than Caucasian men • Men with a family history of prostate cancer have a 2-3x higher risk of diagnosis

  3. Maintain a Healthy Weight • Similar to breast and colon cancer, maintenance of a healthy weight has been shown to reduce the risk of prostate cancer and progression of the disease!

  4. Can we prevent prostate cancer? • PCPT Trial and REDUCE Trial • Finasteride • Dutasteride • SELECT Trial • Vit E and Selenium • Statins • Vitamin D

  5. 5-alpha reductase inhibitors • PCPT Trial: • Finasteride: 5a reductase inhibitor type 2 • Prevalence of prostate cancer reduced by 24.8% (24.4% to 18.4% in those randomized to finasteridevs placebo) • Prevalence of gleason 7-10 tumors higher in the finasteride group vs placebo • Over-detection bias due to gland shrinkage • Prevention of low grade, indolent tumors (gleason sum 6)

  6. 5-alpha reductase inhibitors • REDUCE Trial: • Dutasteride: 5a reductase inhibitor type 1 & 2 • 23% relative reduction in gleason sum 6 cancers • Biopsies performed “for cause” (elevated PSA or abnormal DRE)  16.6% and 16.7% positive in the dutasteride and placebo groups, respectively

  7. If I Take Proscar (Finasteride) or Avodart (Dutasteride) Can I Prevent Prostate Cancer? • Reduction in the number of men who will undergo prostate biopsies…. • PSA more sensitive for detection of high grade tumors…. • Using these drugs for prevention may give men a false sense of security due to depressed PSA levels…. • This may result in delay in diagnosis until they have higher grade disease with less treatment options….

  8. 35,533 men 427 participating sites, activated July 2001 Follow up of minimum 7 yrs, maximum 12 yrs Double blind study Patients assigned to 4 groups: Selenium/placebo, Vitamin E/placebo, Vit E + Selenium/placebo, placebo/placebo August 2001 – June 2004 50 yrs or older (AA men) 55 yrs or older (all other men) PSA 4.0 or less Negative DRE Doses: Selenium (200Ug/d from L-selenomethionine) Vit E (400 IU/d rac-a-tocopherylacetate) SELECT Trial

  9. Results • September 2008 – SELECT Trial stopped based on interim analysis and lack of effect • Median follow up – 5.46 yrs • No differences in cancer endpoints • No difference in prostate cancer incidence between placebo and intervention • HAZARD RATIO: • Selenium/Vit E  1.05 (CI: 0.88 – 1.25) • Vit E  1.13 (CI: 0.95-1.35) • Selenium  1.04 (CI:0.87-1.24) • Placebo  1.00

  10. STATINS and Prostate Cancer • “Statins may lower the risk of prostate cancer and its recurrence after radical prostatectomy.” • Finnish Trial: • 23,320 men in screening arm • Overall prostate cancer incidence decreased by 38% in statin users • Eliminated bias related to those men who undergo routine PSA screening Murtola et al Int J Cancer 2010

  11. STATINS and Prostate Cancer • Thrasher et al - Cancer: June 2008 • 1319 men • 24 mos follow up for men taking statins • 38 mos follow up for men not taking statins • 30% lower risk of biochemical recurrence after radical prostatectomy • Those who are on statins presented intially with lower PSA’s and clinical stages, but were older and had higher BMI’s

  12. Why Vitamin D? • Men living in northern latitudes with less sunlight  higher prostate cancer mortality • Prostate cancer more common in older men in whom Vit D deficiency is more common • African American men  skin melanin blocks ultraviolet radiation and inhibits activation of Vit D • Prostate cancer cells express Vit D receptors • Several studies demonstrate antiproliferative effect of Vit D on prostate cancer cell lines

  13. What should I do to prevent prostate cancer? • Education • Awareness • Understanding risks • Statins show promise • Selenium and Vit E  no effect • 5a reductase inhibitors  continued debate

  14. Thank You

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