Prostate cancer is a common malignancy in men and the worldwide burden of this disease is rising. Lifestyle modifications such as smoking cessation, exercise, and weight control offer opportunities to reduce the risk of developing prostate cancer. Early detection of prostate cancer by prostate-specific antigen (PSA) screening is controversial, but changes in the PSA threshold, frequency of screening, and the use of other biomarkers have the potential to minimise the overdiagnosis associated with PSA screening. Several new biomarkers for individuals with raised PSA concentrations or those diagnosed with prostate cancer are likely to identify individuals who can be spared aggressive treatment. Several pharmacological agents such as 5α-reductase inhibitors and aspirin could prevent development of prostate cancer. In this Review, we discuss the present evidence and research questions regarding prevention, early detection of prostate cancer, and management of men either at high risk of prostate cancer or diagnosed with low-grade prostate cancer.
Bibliographical noteFunding Information:
JC reports grants from Cancer Research UK, Prostate Cancer UK, and the Association for International Cancer Research, during this study; grants and personal fees from Myriad Genetics; personal fees and non-financial support from Bayer; and membership of the advisory board of Myriad Genetics and Bayer, outside the submitted work. MAT reports grants from Cancer Research UK, Prostate Cancer UK, and the Association for International Cancer Research, during this study. GA reports grants from NCI, during this study; personal fees from Augmenix, Bayer, Genomic Health, GlaxoSmithKline, and Myriad Genetics; research grants from Johnson & Johnson, Medivation, and Wilex, outside the submitted work. PHB serves as a Scientific Advisory Board Member for Susan G Komen Foundation, outside the submitted work. RAE reports Medical Education support from Janssen, personal fees, and expenses from Succinct Communications, outside the submitted work. LH reports support from Swedish County Authorities, during this study, in his capacity as the head of a publicly funded regional cancer centre that has the remit to oversee early detection and prevention for cancer in one of six health-care regions in Sweden. HL reports grants from National Cancer Institute (R01CA160816; P50-CA92629) to Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA; grants from David H Koch through the Prostate Cancer Foundation to the Sidney Kimmel Center for Prostate and Urological cancers at MSKCC, New York, NY, USA; grants from Swedish Cancer Society (number 11-0624) to Lund University, Malmö, Sweden; grants from Fundacion Federico SA to Lund University, Malmö, Sweden; and grants from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre Program, University of Oxford, Oxford, UK, during this study; in addition, HL holds a patent for free PSA, intact PSA, and hK2 assays with royalties paid to Arctic Partners, and a patent application for a statistical method to detect prostate cancer filed by Arctic Partners and licensed to OPKO. MM reports grants and personal fees from GlaxoSmithKline and MSD, during this study; grants and personal fees from GlaxoSmithKline and MSD, outside the submitted work. FLM reports travel support from Cancer Prevention Pharmaceuticals, outside the submitted work; FLM is a co-Founder of Cancer Prevention Pharmaceuticals. CP reports grants and personal fees from Bayer; and personal fees from Astellas, BNIT, Janssen, Sanofi-Aventis, and Takeda, outside the submitted work. BT reports personal fees from Amgen; grants and personal fees from Astellas and Ferring; personal fees from Medivation, Bayer, and Dendreon; and non-financial support from IPSEN, outside the submitted work. The other authors declare no competing interests.
We thank Vesna Florijancic, Liz Pinney, and Ellie Stewart for administrative assistance. This Review was sponsored and funded by the International Society of Cancer Prevention (ISCaP), the European Association of Urology (EAU), the National Cancer Institute, USA (NCI) (grant number 1R13CA171707-01), Prostate Cancer UK, Cancer Research UK (CRUK) (grant number C569/A16477), and the Association for International Cancer Research (AICR). Sponsors and funding sources had no role in the discussion or writing of this manuscript. The findings and conclusions in this report are those of the authors and do not represent the official position of the authors' respective institutions.
© 2014 Elsevier Ltd.