Level-1 Data From the REDUCE Study and the PCPT Data

Introduction

Alternatives to waiting for the clinical signs of a disease to become apparent are screening and prevention. These approaches may make treatment more effective and safer. Prostate cancer is seemingly an ideal disease for these approaches as it has a long latent period driven not just by mutation but also by many epigenetic variables, particularly those relating to the action of cell-signaling regulatory molecules, which can also be important determinants during the latent period before invasion and metastasis occur. Pharmacologic modulation of these regulatory pathways, over and above the effective use of drugs and micronutrients that block mutagenic damage to DNA, thus offers great potential for prevention of prostate cancer.

Chemoprevention reduces disease diagnosis by the use of chemical agents, drugs, or food nutrients. With respect to prostate cancer, risk reduction by 5-alpha-reductase (5 AR) inhibitors has been studied in two settings. The first assessed healthy men at low risk of the disease (Prostate Cancer Prevention Trial, PCPT) and the second assessed men at higher risk for the disease because of elevated prostate-specific antigen (PSA) levels. Two large randomized trials have attempted to address the goal of chemoprevention of prostate cancer by pharmacologic intervention in these two populations.

Incidence

In 2013, it was estimated that prostate cancer accounted for 27% (233,000) of incident cancer cases in men . Additionally, prostate cancer also has rising incidence with age. Nonetheless, though prostate cancer was typically a disease of the older man, the era of PSA-based screening has resulted in a trend toward diagnosis in younger men. As such, the 2005 incidence rate of prostate cancer in men younger than 50 is 7.23 times the 1986 incidence rate.

Factors for increased risk of prostate cancer