Division of Urology, University Health Network, University of Toronto, 700 University Ave, Toronto, ON, M5G 1X6, Canada.
World J Urol. 2022 Jan;40(1):61-69. doi: 10.1007/s00345-021-03858-4. Epub 2021 Oct 17.
A sound scientific basis has been emerging on the anti-neoplastic role of metformin, statins and dietary interventions. However, evidence in prostate cancer patients remains mixed owing to an absence of completed randomized trials. This overview examines the rationale for metformin, statins and dietary intervention for secondary prevention in men on active surveillance by summarizing current evidence base and biological mechanisms in influencing cancer progression and mortality.
A comprehensive literature search was performed to identify studies that evaluated the role of metformin, statins and diet in the secondary prevention of prostate cancer as well as those that described the anti-cancer mechanisms of these agents. The search included Pubmed, MEDLINE, EMBASE and Cochrane library from inception till August 2021.
A total of 14 trials on metformin, 21 trials on statins and 13 trials on dietary measures were evaluated. Majority were observational population-based cohort studies or meta-analysis of them. Three ongoing prospective randomized controlled trials were also reported. Overall, mixed results were obtained.
The role of metformin and statins remains promising with several trials showing reduced rates of progression and cancer specific mortality. Combination therapy strategies have also been evaluated in more advanced patients showing synergism. Dietary interventions especially fruits, vegetables and fish intake has shown some benefit albeit with mixed results for others like legumes, red meat, coffee and multivitamins. Several ongoing randomized trials will provide stronger evidence in the future for secondary prevention.
二甲双胍、他汀类药物和饮食干预在抗肿瘤方面的作用已经有了坚实的科学依据。然而，由于缺乏完成的随机试验，前列腺癌患者的证据仍然存在分歧。本篇综述通过总结目前影响癌症进展和死亡率的生物学机制方面的证据，探讨了二甲双胍、他汀类药物和饮食干预在主动监测男性中的二级预防作用的基本原理。
通过检索 Pubmed、MEDLINE、EMBASE 和 Cochrane 图书馆，从建库到 2021 年 8 月，全面检索评估二甲双胍、他汀类药物和饮食在前列腺癌二级预防中的作用，以及描述这些药物抗癌机制的研究。
共评估了 14 项关于二甲双胍的试验、21 项关于他汀类药物的试验和 13 项关于饮食措施的试验。大多数是观察性的基于人群的队列研究或对这些研究的荟萃分析。还报告了三项正在进行的前瞻性随机对照试验。总的来说，结果喜忧参半。
二甲双胍和他汀类药物的作用仍然很有前景，多项试验显示进展率和癌症特异性死亡率降低。联合治疗策略也在更晚期的患者中进行了评估，显示出协同作用。饮食干预，特别是水果、蔬菜和鱼类的摄入，显示出一些益处，尽管其他如豆类、红色肉类、咖啡和多种维生素的结果喜忧参半。未来，几项正在进行的随机试验将为二级预防提供更强有力的证据。
