Urology Medical News about Prostate cancer, chemoprevention, finasteride

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Chemoprevention of prostate cancer
The Journal of Urology, 07/20/09

Thompson IM et al. - In a review of the most recent results of large-scale randomized clinical trials on chemoprevention of prostate cancer (PCa), it was concluded that recommendations for prevention of PCa must be based on outcomes of well designed randomized trials. Men undergoing PCa screening should be informed of the potential for reduction in risk with finasteride.

Methods

Potential agents, their hypothesized mechanisms of action, and challenges for the design of chemoprevention trials were reviewed, including 3 large scale trials SELECT (testing selenium and vitamin E), PCPT (testing finasteride), and REDUCE (testing dutasteride).

Results

Initial results of SELECT demonstrate no impact of selenium or vitamin E on the risk of PCa.
The REDUCE trial results should be available within the year.
Results of the PCPT demonstrate a significant (measured relative risk reduction of 24.8%) reduction in the risk of PCa.
Initial observation of an excess risk of high-grade disease appears to be related to improved detection of cancer and high-grade cancer related to the improved sensitivity of prostate-specific antigen, digital rectal examination, and prostate biopsy for cancer and high-grade cancer detection.
Modeling studies suggest that with finasteride the risk of high-grade cancer is unchanged or reduced.
Sexual dysfunction and gynecomastia were observed but the rates were low.

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