Rittmaster Roger S, Fleshner Neil E, Thompson Ian M
Oncology Clinical Development, GlaxoSmithKline, Research Triangle Park, North Carolina 27709, USA.
Eur Urol. 2009 May;55(5):1064-73. doi: 10.1016/j.eururo.2009.01.037. Epub 2009 Feb 5.
It is now possible to reduce a man's risk of developing biopsy-detectable prostate cancer. This review addresses the evidence and issues surrounding prostate cancer risk reduction.
The scientific basis, therapeutic approach, and risks and benefits of prostate cancer prevention are reviewed. Special attention is given to data on 5alpha-reductase inhibitors (5-ARIs).
Medline searches consisted of articles published since 2003 regarding prostate cancer chemoprevention, prevention, or risk reduction, as well as searches around specific topics within this review.
Current data support the use of finasteride for prostate cancer risk reduction in appropriately selected men. The initial concern that finasteride increased the incidence of high-grade prostate cancer has not been confirmed by subsequent analyses. The efficacy of dutasteride, a dual 5-ARI, for prostate cancer risk reduction is currently being evaluated in men with elevated prostate-specific antigen (PSA). Other medical approaches to prostate cancer risk reduction, including statins, cyclooxygenase-2 (COX-2) inhibitors, selective estrogen receptor modulators, and dietary supplements, await validation in controlled clinical trials.
It is now possible to reduce an individual man's risk of developing biopsy-detectable prostate cancer. The greatest benefit arises from decreasing the amount of unnecessary treatment in men harboring low-risk cancers. Presently, there is no evidence that 5-ARIs or any other approach to prostate cancer risk reduction will reduce the risk of lethal prostate cancers. Finasteride, however, does enhance the utility of PSA for diagnosing high-grade cancers.
现在有可能降低男性患活检可检测前列腺癌的风险。本综述探讨了围绕前列腺癌风险降低的证据和问题。
对前列腺癌预防的科学依据、治疗方法以及风险和益处进行综述。特别关注5α-还原酶抑制剂（5-ARIs）的数据。
通过检索Medline数据库获取自2003年以来发表的有关前列腺癌化学预防、预防或风险降低的文章，以及围绕本综述中特定主题的检索结果。
目前的数据支持在适当选择的男性中使用非那雄胺降低前列腺癌风险。最初关于非那雄胺增加高级别前列腺癌发病率的担忧未得到后续分析的证实。目前正在对患有前列腺特异性抗原（PSA）升高的男性评估双重5-ARI度他雄胺降低前列腺癌风险的疗效。其他降低前列腺癌风险的医学方法，包括他汀类药物、环氧合酶-2（COX-2）抑制剂、选择性雌激素受体调节剂和膳食补充剂，有待在对照临床试验中得到验证。
现在有可能降低个体男性患活检可检测前列腺癌的风险。最大的益处在于减少患有低风险癌症男性的不必要治疗量。目前，没有证据表明5-ARIs或任何其他降低前列腺癌风险的方法会降低致命性前列腺癌的风险。然而，非那雄胺确实提高了PSA用于诊断高级别癌症的效用。
