Social behavior and prostate cancer prevention


In another front-page article this morning, the New York Times discusses the failure of potential patients and the medical community to take seriously the opportunities actually proven to prevent certain types of cancer.

Specifically, the article discusses the widespread disinterest in the use of finasteride and dutasteride even by patients at significant risk for prostate cancer and in the use of raloxifene and tamoxifen for the prevention of breast cancer.

The 5α-reductase inhibitors or 5ARIs (finasteride and dutasteride) have both been clearly shown, with so-called category 1 evidence, to reduce the risk for prostate cancer by about 25 percent. In the case of breast cancer, raloxifene and tamoxifen have been shown to reduce the risk of breast cancer by more like 50 percent!

It seems so odd that we are more than willing to take a slew of different drugs to prevent various type of heart disease, and yet we are unwilling to “buy in” to the idea of drug therapy to prevent common forms of cancer. Equally amazing is the fact that people will spend hundreds of dollars a year on forms of over-the-counter supplement that have clearly been shown not to work in the prevention of cancer.

It seems likely, however, that if we could develop a “prostate cancer vaccine” that could be given to boys some time in their youth, a large percentage of parents would want their sons to have this vaccine. The problem is that that type of vaccine (to date) only works when it stops people getting an infection. While prostate cancer has been “associated” with the presence of certain types of virus over the years (the most recent candidate being the XMRV virus), there is still no evidence that a virus actually causes a patient to get prostate cancer. By contrast, cervical cancer has been very clearly shown to be the consequence, in a very high proportion of women, of infection with certrain types of human papilloma virus (HPV), which is why the recently developed vaccines have been so effective in reducing the risk for cervical cancer.

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