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INTRODUCTION

Early detection and effective treatment of prostate cancer (PCa) have reduced mortality related to PCa and focused attention on the complications of treatment and their adverse effect on quality of life. This chapter reviews the adverse effects of the therapeutic interventions for prostate cancer and discusses strategies to reduce their occurrence and to treat them, with the goal of optimizing the benefit-to-harm ratio.

PROSTATE CANCER

Epidemiology, Causes, Risk Factors, and Prevention

PCa is the most common solid cancer in men; it is the second most prevalent cancer in men after skin cancer. One in 9 men will be diagnosed with PCa during their lifetime, and 1 in 41 men with PCa will die from their disease. In 2018, 164,690 new cases of PCa were diagnosed and 29,430 deaths were attributed to the disease in the United States.1 It is the second leading cause of cancer death after lung cancer in men.

Many risk factors have been associated with an increased risk of developing prostate cancer. However, none has a direct causal effect (Fig. 27-1). Some of these risks are uncontrollable, whereas others are related to the patient’s lifestyle and exposure in everyday life. PCa is rare in men under 40 years of age but is common in older men. Eighty percent of prostate cancers are diagnosed in men over the age of 65. In fact, the diagnosis of this disease at an older age and the life expectancy of a patient are key factors in directing therapeutic interventions. African American race and a family history of PCa in a first-degree sibling significantly increase the risk of PCa.

FIGURE 27-1

The established risk factors for prostate cancer.1,3 Age, race, family history, and PSA levels are among the most important predictors of PCa. Additional factors associated with PCa include smoking and diet.

Diet, eating habits, and environmental exposures are considered “soft” risk factors. It has been difficult to prove a causal relationship between these risk factors and the development of PCa. Research in this area is subject to various biases and confounding variables. Dietary factors, such as increased consumption of red meat and dairy products, are associated with a slightly increased risk of PCa. Obese patients are at higher risk of getting more aggressive PCa. Limited evidence has linked Agent Orange to PCa, and many studies have linked smoking to the disease as well.

Protective factors against PCa include physical activity and a healthy, balanced diet. Vitamins and other supplements have failed to show any benefit. Long-term use of medications such as aspirin and steroid 5-alpha reductase inhibitors might be beneficial in reducing PCa risk in a subgroup of patients. The Prostate Cancer Prevention Trial (PCPT), a randomized, placebo-controlled clinical trial, studied 18,882 men aged ...

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