Chapter 10 – Prostate Cancer Prevention: Strategies and Realities

The molecular and genetic events underlying prostate cancer begin decades before clinically significant disease is detected. The interaction of genetics and environmental influences in the development of prostate cancer is significant given the prolonged natural history of the disease. Most risk factors associated with significant prostate cancers including age, race, and genetics are non-modifiable. However, there is a growing awareness of modifiable risk factors such as diet and environmental factors, which require systematic study. Most previous disease prevention strategies have focused primarily on avoidance behaviors. However, currently, chemopreventive agents are increasingly used to disrupt one or more steps involved in carcinogenesis. The molecular targets for candidate prostate cancer prevention agents include sex steroid signaling differentiation and proliferation, angiogenesis, and pro-apoptotic pathways. Prostate cancer risk assessment programs such as the Prostate Cancer Risk Assessment Program (PRAP) and Prostate Cancer Risk Registry (PCRR) provide integrated multidisciplinary approaches to screening, counseling, and researching preventive efforts. For prostate-cancer-prevention efforts to be successful, they must be studied systematically across multiple medical, social, and economic disciplines. Chemopreventive strategies must start early in the disease process and follow-up must be rigorous and extend over decades. Programs such as PCRR and PRAP must be integrated into NCI-sponsored studies, such as SELECT and Prostate Cancer Prevention Trial (PCPT). Finally, chemoprevention and risk assessment programs must serve as a catalyst for the development of educational training tools directed toward community-based health care professionals and their patients.