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Yale-New Haven was recognized this year by U.S. News & World Report for its cancer services.

Prevention is always the first line of defense

These studies along with others emphasize the importance of preventing prostate cancer. It's better to prevent it in the first place than to get it and have to treat it. As a medical oncologist, I don't have a lot of therapies available to treat prostate cancer. Unlike treatment of breast cancer, where many types of drugs are available, we only have three or four chemotherapy treatments for prostate cancer. So it's clearly better to prevent it.

These studies give doctors clearer information about how to accomplish this. Prostate cancer is a good choice for a prevention trial because of its incidence, prevalence and disease-related mortality. It is a good candidate for a preventive strategy for two reasons:

• Men rarely get prostate cancer before the age of 50; and
• It usually is a slow developing cancer.

Treatment options
In prostate cancer, we have basically three treatments to offer:

• Do nothing. Older men sometimes choose this option if their age is advanced and the cancer is slow growing. Many times, a man will die of other causes before the cancer takes its toll.
• Surgical removal of the prostate
• Radiation—either external beam or radioactive implants

Hormone therapy may also be used to supplement these therapies.

Prostate cancer common
Next to skin cancer, prostate cancer is the most common type of cancer in U.S. men. This year alone, there will be an estimated 232,000 new cases of prostate cancer and more than 30,000 U.S. deaths. That means approximately one in six U.S. men, or 17.8 percent, will develop prostate cancer during his lifetime.

We simply don't have a good cure rate. All men are at risk, but age 55 or older, being African-American or having a first-degree relative with the disease increases one's risk. More than 92 percent of cases affect men age 55 and older.

Selenium, vitamin E fight cell damage
Selenium and vitamin E are thought to help prevent cells from changing, the first step in stopping cancer. When the DNA in cells is attacked on a number of fronts—by air pollution, chemicals, poor diet, radiation and environmental factors—normal cells can change into cancer cells. We have a better understanding of why some cancers start to grow. In some leukemias, for example, the trigger is a fusion of two chromosomes.

In prostate cancer, we don't know why it starts. In many men, the prostate will grow to a certain size and stop. In others, it might grow uncontrollably. Researchers are trying to figure out what causes the lack of control or cancerous growth.

Antioxidants like vitamin E, beta carotene and selenium have been studied for their role in preventing cancer. While the results of this SELECT study aren't in yet, it looks promising. Beta carotene, however, wasn't shown to be helpful in earlier studies.

It is generally thought that selenium and vitamin E stop the chemical reaction that occurs when cells are attacked. Oxygen in the body can create damaging by-products, called free radicals, during normal cellular metabolism. Free radicals can cause cell damage, leading to cancer, heart disease and a weakened immune system. Antioxidants counteract free radicals, binding with them before they cause damage.

Antioxidants found in food
Selenium, a nonmetallic trace element, comes from food, especially rice, wheat, seafood, meat and Brazil nuts. Vitamin E also comes from food, especially vegetables, vegetable oils, nuts and egg yolks

Finasteride also found helpful
In the Prostate Cancer Prevention Trial (PCPT), finasteride was used to see if it could curtail the hormone that would make the prostate grow. Finasteride, a type of hormonal therapy, prevents production of certain male hormones.

This study showed that finasteride can prevent prostate cancer. One caveat, however—while men taking finasteride got fewer instances of prostate cancer, when they did get prostate cancer, their form of the disease was more likely to be more aggressive.

Talk to your doctor first
Going forward, men should be aware of the options available to them and talk to their primary care provider about using antioxidants to prevent prostate cancer. I wouldn't start taking these antioxidants without first discussing it with your doctor.

All the evidence isn't in yet, but the future looks promising for use of antioxidants and finasteride in prevention of prostate cancer. It's an area of medicine where we'll only improve in the next few years.

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Hari Deshpande, MD, is an attending oncologist at Yale-New Haven Hospital, a member of the Yale Cancer Center and assistant professor at Yale School of Medicine.