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

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

3. 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.

4. 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.

5. 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.

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

7. 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.

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

9. 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

10. 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?