COMMENTARY

Advances in Prostate Cancer: 2014

Gerald Chodak, MD

Disclosures

December 11, 2014

In This Article

The year 2014 has again provided important developments in the area of prostate cancer. New data and new treatments span the spectrum of prostate cancer management, from prevention and screening to optimal strategies for localized, locally advanced, and metastatic disease.

Prostate Cancer Prevention

Epidemiologic and case-control studies have suggested that several agents may lower the risk for prostate cancer; however, these types of studies are not sufficient to prove benefit. Randomized controlled trials have been conducted with 5-alpha reductase inhibitors, vitamin E, and selenium. For example, studies that were not designed specifically for prostate cancer suggested these agents were effective in preventing prostate cancer.

The SELECT trial[1] was a randomized controlled study designed to evaluate vitamin E, selenium, and the two in combination in the prevention of prostate cancer. Unfortunately, this study failed to show a benefit from either supplement. Many people were critical of the choice of vitamin E and selenium; these agents were chosen because they had been used in the studies that formed the basis for the SELECT trial.

Now, an update[2] of this study has shown that these agents actually harmed some men. Men with high levels of toenail selenium upon entering the study and who were randomly assigned to receive selenium (either with or without vitamin E) had a 91% increase in high-grade prostate cancer. In addition, men with low selenium levels who received vitamin E alone had a significantly increased risk for total, low-grade, and high-grade prostate cancer.

These findings have two important implications. First, the public needs to recognize that it is false to assume herbs, vitamins, and supplements cannot cause harm. Second, this study again illustrates the importance of properly testing supplements in randomized trials rather than making conclusions from epidemiologic or uncontrolled case studies.

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