The risk of a man’s developing prostate cancer is approximately 18%. Whereas it has been estimated that as much as 60% of this risk is due to environmental exposure (J Urol. 2007;178:S9-S13), developing strategies to mitigate this risk is an important public heath concern.
The Prostate Cancer Prevention Trial was the first to demonstrate a statistically significant reduction in the diagnosis of prostate cancer following treatment with the 5α-reductase inhibitor finasteride (N Engl J Med. 2003;349:215-224). Additional large-scale phase 3 chemoprevention trials have either completed accrual or are close to completing it. Despite level I evidence demonstrating ability to prevent the disease, concerns remain and clinical adoption of prostate cancer chemoprevention strategies is low.
Varying degrees of evidence suggest that decreased dietary fat; lycopene; antioxidants, such as selenium and vitamin E; nonsteroidal anti-inflammatory drugs; and selective estrogen receptor modulators may prove beneficial in decreasing the risk of developing prostate cancer. Unfortunately, it will take many years and carefully designed, expensive, large-scale clinical trials in specific populations to sort this out.
Meanwhile, sons and grandsons of men with prostate cancer who want to mitigate their own risk search out “solutions.”A Google search of “prostate cancer prevention” turns up about 427,000 hits that offer advice on diet, supplements, and such formulations as “Maximum Prostate” and “Prostate Power.”
The largely unregulated multibillion dollar nutraceutical industry is replete with overstated, carefully worded innuendos regarding potential benefits to prostate “health.” Here, industry trumps science while offering little in return. If government won’t provide strict oversight or mandate regulatory approval of these products, shouldn’t it at least require industry to shoulder the burden of the research effort? Requiring a small portion of the sales of prostate herbal supplements to flow back into the National Cancer Institute for the advancement of real science is no different than asking the tobacco industry to help fund anticancer efforts. Such an arrangement, as it pertains to nutraceuticals, is only “natural.”
Dr. Uzzo is the Renal & Urology News medical director for urology. He is the G. Willing Pepper Chairman of the Department of Surgery and Member in Urologic Oncology at Fox Chase Cancer Center in Philadelphia.