In men, prostate cancer is the most common internal cancer and the second most common cause of cancer death. Lifetime risk is 1/6. For 2003, it is estimated that 221,000 new cases of prostate cancer were diagnosed and 29,000 men died as a result of this disease . Specific causes are unknown but ample evidence points to genetic, hormonal, environmental and socio-economic factors that, individually and in combination, are reasons for cancer development. Known risk factors are advancing age, African American race, family history (especially father or brother), diets high in animal fat, elevated prostate specific antigen and high grade prostate intraepithelial neoplasia, a precancerous condition of the prostate gland. Of particular significance is the impact of prostate cancer on African Americans, as black men have the highest prostate cancer rates of any ethnicity. Incidence is 50% greater than in Caucasian men. Even more disturbing is that the mortality rate for African Americans with prostate cancer is 100% greater than in Caucasian men.

It is very important that men of all races know if prostate cancer runs in their family, since men with a first-degree relative who has or has had prostate cancer are at a 2-3 fold risk increase for developing the disease. This risk is even further increased with additional affected relatives.

Characteristics of hereditary prostate cancer include the following:
• Develops earlier than 65 years old
• More than one family member affected
• Spans at least two generations

The mainstay of prostate cancer detection is a screening exam, which is comprised of two parts: a digital rectal exam and prostate specific antigen (PSA) blood test. A prostate biopsy is performed if the result from either one of these parts of the screening exam is suspicious for cancer. The biopsy is used for definitive diagnosis. The following general guideline should be used to determine when a man is to begin receiving his annual prostate screening exam: Screening should begin at age 40 for high-risk men (ie, men who are African American or have a family history of prostate cancer) and by age 45 for all other men.

Healthy diet and other prevention techniques are perhaps the most important areas of focus in recent developments for combating prostate cancer. Diets low in animal and saturated fats but rich in vitamin E, lycopene, selenium, soy and other antioxidants have consistently shown to mitigate risk of prostate cancer incidence. Moreover, primary prevention of prostate cancer through dietary supplementation with antioxidant vitamins and minerals is a very promising strategy. The use of such natural and even synthetic substances to prevent cancer is known as chemoprevention. Chemoprevention is also important for inhibiting or delaying the progression of prostate cancer that is already present.

Large-scale prostate cancer chemoprevention studies, unheard of until quite recently, are being conducted more and more by pharmaceutical companies as well as government research entities, such as the National Institutes of Health and the National Cancer Institute (NCI). These studies are investigating whether or not certain dietary supplements, hormonal substances, and medications currently marketed for other uses can prevent the development of cancer. My practice, Midtown Urology, is currently conducting three (soon to be four) different prostate cancer chemoprevention clinical trials on behalf of NCI and pharmaceutical firms. Perhaps the most significant of these is the NCI-sponsored Selenium and Vitamin E Cancer Prevention Trial (SELECT) designed to determine if selenium and/or vitamin E can prevent prostate cancer. This study is double-blind, placebo-controlled and is taking place at over 400 sites in the United States, Canada, and Puerto Rico. Each participant has a 25% of being randomized to one of four study arms: vitamin E and selenium, vitamin E only, selenium only, or neither vitamin E nor selenium (ie, placebo). Of note, enrollment for this study is ending in June 2004 (two years earlier than scheduled!) due to achieving the enrollment target of 32,400 healthy men.

SELECT is of great importance to society because so many men already take selenium and/or vitamin E for their health. Much indirect evidence exists from previous research that points to the prostate cancer prevention properties of selenium and vitamin E. SELECT will finally enable us to definitively determine whether or not there is merit to these earlier findings. SELECT is slated to end in the year 2011, at which time all study participants will have been taking the study supplements for between 7 and 10 years, depending on the year they enrolled. At the end of the study, all participants will be informed of the study arm they were in.

It is of utmost importance that patients and health care providers alike become more proactive in using the strategy of prevention, rather than treatment, to fight prostate cancer. Although current prostate cancer treatments are very advanced and usually successful, patients many times suffer debilitating complications as a result of therapy. Accordingly, prevention efforts need to become the modus operandi for all men and medical professionals everywhere.