Prevention of Prostate Cancer. Fact or Fiction? J.Edson Pontes XIV Oncologic Urology Workshop Professor Urologic Oncology WSU/KCI

Options of Pharmacologic Prevention Diet: Western vs. Asian Diet Supplements: Selenium, Licopenes, Soy, Zinc, etc.. Pharmacologic Intervention: 5-ARIs.

Pharmacological basis of 5ARIs. Prostate disease development is associated with increased expression of 5ARIs. Finasteride inhibits type 2 5ARIs. Dutasteride is a dual 5ARIs inhibitor.

Natural History of Prostate Cancer Single Cell Model- Long Period of Latency Multiple Foci of Pre-Malignant Lesions (HGPIN), multifocal tumors. Unknown period of latency.

The influence of Finasteride on the development of PCA. 18,000 men >55 years old,PSA<3,normal DRE,randomized to Finasteride or Placebo. Biopsy for abnormal DRE or PSA>4. Reduction of PCA in 24% of men on Finasteride. But increase in cancers with Gleason score>7 in the Finasteride group.

REDUCE TRIAL Four year multicenter, randomized, double blind, placebo controlled. Dutesteride vs. Placebo Age: 50-75 years of age, PSA: 2.5-10ng/ml, one negative biopsy. Patients underwent biopsy at 2 and 4 years.

RESULTS Number: 6729 men underwent biopsy. 659/3305 with cancer in the Dutasteride group. 858/3424 with cancer in the placebo group. Risk reduction of 23% of cancer. No difference in Gleason >7 in both groups in years 1 to 4.

Differences between: PCPT and REDUCE REDUCE- 83% biopsy vs. <50% PCPT. No difference between Gleason 7-10 Klotz Eur.Urol. 2010

Views from Experts The Prevention vs. Delay argument is a distinction without difference. Howard Parnes NCI cancer prevention. Disappointed that Dutasteride was not effective in preventing high grade tumors. Pat Walsh Lies, Damn Lies, and cancer statistics! Peter Albertson

Conclusions Are the statistical differences observed in both studies, the result of prevention, or elimination of low grade prostate cancer? At which age should intervention start to prevent prostate cancer? Are side effects acceptable on long term basis?