Medications

The idea that specific medications may prevent the emergence or recurrence of prostate cancer arose primarily from observations on finasteride (Proscar). This substance blocks the enzyme that converts testosterone to dihydrotestosterone (DHT), thereby reducing the size of the prostate. It has proven especially effective as a treatment for benign prostatic hypertrophy (BPH).

A trial of finasteride in the prevention of prostate cancer began in 1993 with over eighteen thousand men (Prostate Cancer Prevention Trial). The results, published in 2004, showed that finasteride ''did

Caution: The Molière Principle

Molière, the seventeenth-century French playwright, once wrote: ''Nearly all men die of their remedies, and not of their illnesses.'' This principle is important to remember when attempting to prevent prostate cancer. Excessive consumption of selenium may produce abdominal pain, arthritis, emotional instability, hair loss, and liver dysfunction. Excessive consumption of vitamin E may increase a bleeding tendency and the incidence of strokes. Excessive consumption of vitamin D may produce kidney damage, and excessive exposure to sunlight as a way of increasing vitamin D absorption may lead to skin cancers. Excessive consumption of vitamin A may produce hair loss, elevated blood lipid levels, neurological symptoms, and liver damage.

indeed significantly reduce the prevalence of prostate cancer but did so at a disturbing price: the possibility that if cancer is detected, it may be of a higher pathological grade.''11 The reduction in prostate cancer was 25 percent, but this good news was offset by the bad news that the cancers that did occur were more malignant than expected. Thus, it is not recommended that finasteride be used to prevent prostate cancer.

Tests of other medications to reduce prostate cancer are in progress, including a trial of dutasteride, a drug similar to finasteride, in eight thousand men (the REDUCE study). Statins, used to lower cholesterol, have shown some promise; one study reported that statin use decreased PSA, and another found that it decreased the incidence of prostate cancer. However, in 2006 a large study of statins concluded that they had no effect on any cancers, including cancer of the prostate.12 Also being investigated are drugs that decrease inflammation; studies of long-term aspirin users suggest that aspirin may lower the risk of developing prostate cancer.13 A study of rofe-coxib (Vioxx), a cyclooxygenase (COX-2) inhibitor, was under way until the drug was withdrawn in 2004 because of its cardiac side effects. Research on another COX-2 inhibitor, celecoxib (Celebrex), is planned.

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