Prostate cancer prevention

The term chemoprevention, as it relates to prostate cancer and other malignancies, is the practice of employing pharmacological or naturally occurring agents to inhibit the carcinogenic evolution of normal epithelial cells to volatile and potentially dangerous malignant cells. As malignancies such as prostate cancer may take many years to reach an invasive state, mechanisms to control, and even reverse, its protracted course are highly sought after. Epidemiologically, prostate cancer is the most prevalent noncutaneous malignancy among men, accounting for 43% of all diagnosed cancers. An estimated 220 800 cases of prostate cancer will be diagnosed in the USA in 2015, with a mean age at diagnosis of 66 years. Management of prostate cancer can be expectant, as exemplified by a watchful waiting strategy, or aggressive, as in radical prostatectomy or radiation therapy. In recent years, active surveillance has been favoured over watchful waiting as an expectant management strategy for men with a life expectancy of 10 or more years. A diagnosis of prostate cancer may be the source of considerable anxiety to the patient and his family irrespective of prognosis and proposed management, and represents a substantial cost to the health‐care system. Thus, preventing this common and potentially morbid disease altogether is a preferable route. This chapter will endeavour to provide an evidence‐based summary of prostate cancer prevention strategies, with a focus on pharmacological interventions and cancer prevention trial design.