Use of PSA to Evaluate Risk and Progression of Prostate Cancer

During the past two decades, a better understanding of tumor biology has led to increased interest in the concept of cancer prevention. Chemoprevention involves inhibiting carcinogenesis through application of noncytotoxic nutrients and pharmacologic compounds, thereby preventing the development and progression of malignant cells. Prostate cancer is one of the primary targets for chemopreventive studies. It has a long latency period, and autopsy series demonstrate that the probable precursors to prostate cancer are identifiable decades before presence of the disease. It was reported that prostatic epithelial neoplasia (PIN), a premalignant condition, can occur in men as young as 30 yr of age (1). Because it takes a long time to go from the precursor lesion to cancer development, therapies do not reverse the premalignant condition, though the type of disease presentation affects ultimate survival. Along with interest in cancer chemoprevention have come a number of new challenges, including identification of high-risk groups as well as assessing response to intervention. Chemoprevention should benefit men in the general population, especially those with high risk of developing cancer. Those with high-grade PIN in a prostate biopsy specimen, men with a family history of prostate cancer, and African-American men may gain additional benefits from chemopreventive measures.