ALEXANDRIA, Va. — A newly released joint guideline produced by the American Society of Clinical Oncology (ASCO) and the American Urological Association (AUA) recommends that healthy men who are screened regularly for prostate cancer and show no symptoms of the disease should talk to their doctors about using a 5-alpha reductase inhibitor (5-ARI) to prevent the disease. 5-ARIs lower the level of the hormone dihydrotestosterone (DHT), which can contribute to the growth of prostate cancer.
This guideline aims to provide a useful tool for clinicians and their patients in making an informed decision about the potential benefits and risks of taking 5-ARIs for preventing prostate cancer and examines the use of 5-ARIs as a method of "chemoprevention" for prostate cancer. Chemoprevention is the use of a natural, synthetic or biologic substance to reverse, suppress or prevent the development of cancer. Currently, 5-ARIs are used to treat other non-cancerous conditions, such as male-pattern baldness and benign prostatic hyperplasia.
Prostate cancer is the most common non-skin cancer among men and the second-leading cause of cancer death in men. "Although one in every six men in the United States will be diagnosed with prostate cancer, we are not recommending that all men take 5-ARIs," said Barnett S. Kramer, MD, MPH, Associate Director for Disease Prevention at the National Institutes of Health and co-chair of the guideline panel. "However, we would encourage men to begin a dialogue with their doctors to determine if they could benefit from taking 5-ARIs to reduce their prostate cancer risk."
The key recommendations in the guideline include:
- Men with a prostate-specific antigen (PSA) score of 3.0 or below who are screened regularly (or plan to get yearly PSA tests) and currently show no signs of prostate cancer are encouraged to talk with their doctor about the risks and benefits of taking a 5-ARI to further prevent their likelihood of getting prostate cancer
- Men who are already taking a 5-ARI for other conditions should talk to their doctor about continuing to use this drug for the prevention of prostate cancer
The ASCO/AUA recommendations on chemoprevention for prostate cancer are based on evidence gathered from clinical trials, including the Prostate Cancer Prevention Trial (PCPT), in which participating men took a 5-ARI for one to seven years. Trial data showed an overall relative risk reduction of approximately 25 percent in most men who took a 5-ARI to prevent prostate cancer.
"Although a large clinical trial has shown that 5-ARIs can decrease the incidence of prostate cancer, we are still not able to determine if the mortality from prostate cancer is reduced," said Paul F. Schellhammer, MD, a past president of the AUA and co-chair of the panel that developed the guideline. "However, the demonstrated effect of 5-ARIs in reducing prostate cancer incidence makes it reasonable to recommend them for use to prevent the disease. But, as with any drug, patients should discuss the risks and benefits with their physicians."
In conjunction with this guideline, ASCO developed a Decision Aid Tool, which uses straightforward charts and diagrams to explain the risks and benefits of 5-ARIs to patients and their families. One section, called "Thinking It Over," encourages patients to discuss potential treatment decisions with their doctors and their family and determine what risks and benefits matter most to them.
The guideline will be published in the March issue of the Journal of Clinical Oncology and the March issue of The Journal of Urology®. Along with the new guideline and the Decision Aid Tool, ASCO has released a corresponding patient guide available on ASCO's patient Web site, www.cancer.net.
The guideline will be announced by lead author Barnett Kramer, MD, in an embargoed ASCO presscast (press briefing via live webcast), on Tuesday, February 24 from 12:00-1:30 PM (EST). For more information, or to register to participate in the presscast, visit www.asco.org/GUpresskit09 or contact Kelly Powell at kelly.powell@asco.org or 571-483-1365. To speak with AUA Past President and Panel Representative Paul F. Schellhammer, MD, please contact Lacey Dean at ldean@auanet.org or 410-689-4054.
Panel members included Barnett S. Kramer, Karen L. Hagerty, Stewart Justman, Mark R. Somerfield, PhD, Peter C. Albertsen, MD, William J. Blot, Ballentine H. Carter, MD, Joseph P. Costantino, Jonathan I. Epstein, MD, Paul A. Godley, Russell P. Harris, Timothy J. Wilt, MD, Janet Wittes, Robin Zon, and Paul Schellhammer, MD.
"Use of 5-alpha Reductase Inhibitors for Prostate Cancer Chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline" by Barnett S. Kramer, et al., National Cancer Institute Division of Cancer Prevention, Bethesda, MD.
This guideline is being published in the March print issue of the Journal of Clinical Oncology (JCO), the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), and in the March print issue of The Journal of Urology®, the official journal of the American Urological Association.
For a copy of the guideline and available supplemental materials, visit www.asco.org/guidelines, or e-mail: guidelines@asco.org.
About ASCO: The American Society of Clinical Oncology (ASCO) is the world's leading professional organization representing physicians who care for people with cancer. With more than 25,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. For ASCO information and resources, visit www.asco.org/presscenter. Patient-oriented cancer information is available at www.cancer.net.
About the AUA: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 16,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
Journal
The Journal of Urology